Irritable Bowel Syndrome – What is IBS and what are the treatments?
The aim of this report is to provide information on Irritable Bowel Syndrome (IBS) and inform those diagnosed with IBS about the treatments available.
IBS is a common condition of the small and large intestine, or ‘bowel’. It affects about 15% of the population and of those affected, about 9% are female and 6% are male. IBS is a functional condition, meaning that it disrupts bowel function but does not cause detectable abnormalities in the structure of bowel. This can lead to doctors and the public trivialising the condition, even though it affects patients’ quality of life by causing pain, problems associated with passing faeces and psychological issues such as depression.
The Digestive System
The body’s cells require many different molecules and ions to function; it is the digestive system (shown in Figure 1) which supplies these nutrients. The term ‘digestion’ encompasses ingestion, digestion (the breakdown of food into its component nutrients), absorption of nutrients and excretion of waste products.
During ingestion, food is placed into the mouth, chewed and mixed with saliva to form a soft mass, or bolus. Saliva contains enzymes which catalyse, or speed up, the breakdown of food. After the bolus is swallowed, it travels down the oesophagus into the stomach, aided by peristalsis (muscular contractions which travel down the particular organ).
In the stomach, gastric juices including hydrochloric acid and enzymes break down the bolus into a liquid called chyme. The chyme enters the small intestine along with pancreatic juices containing enzymes, and bile (which is produced by the liver and
stored in the gall bladder), where it is fully digested. The nutrients released are absorbed through blood vessels in the small intestine. Peristalsis pushes the undigested matter, including fibre, resistant starch and bacteria into the large intestine (which is divided into the cecum, colon and rectum). Once in the colon, water is absorbed, turning the matter into faeces. The faeces moves into the rectum by peristalsis, after which it is excreted from the anus.
What are the symptoms?
The severity of IBS symptoms vary but are usually worse in the morning and after eating. Typical symptoms include painful abdominal cramps, which ease after passing faeces, abdominal bloating, flatulence, changes in the consistency of faeces (ranging from diarrhoea to constipation) and passing mucus with faeces. Sufferers may also feel the sudden need to empty their bowels or feel that their bowels are not empty despite having been to the toilet. Other symptoms can include feeling sick, back ache, lethargy, bladder problems including the urgent need to urinate, difficulty emptying the bladder and incontinence and dyspareunia, or pain during sex.
IBS is unpredictable in that sufferers may experience no symptoms for months, then experience a ‘flare-up’ for no discernible reason. Symptoms may settle within 2 to 3 days or can take months to settle.
IBS has also been linked with psychological problems such as depression and anxiety. It has been estimated that 3 in 4 sufferers will develop depression and about 50% will develop Generalised Anxiety Disorder (GAD).
What are the causes?
The exact cause of IBS is unknown although several theories have been proposed. Some experts believe that IBS is caused by a change in the speed at which chyme is processed through the bowel; slower processing allows the colon more time to absorb water, causing constipation by making faeces harder and more difficult to excrete. If processed more quickly, less water is absorbed, resulting in diarrhoea. A second theory is that IBS is caused by disruption to nerve signals between brain and bowel, increasing sensitivity to pain, so that mild indigestion to a non-sufferer may cause severe pain to IBS sufferer.
Both of these changes may be linked to food poisoning or intolerance to certain foods. Another theory suggests that these changes may be caused by stress, anxiety or trauma during childhood (such as abuse or neglect), which decreases the level of the neurotransmitter serotonin in the body. Serotonin is produced by the brain and intestines, and is important in controlling mood and digestion. Reduced serotonin levels have been linked to depression and slow peristalsis in the bowel, leading to constipation. Higher levels of serotonin in the body can increase peristalsis, causing diarrhoea; this theory may help to explain the link between IBS and depression.
IBS may also be related to Small Intestinal Bacterial Overgrowth (SIBO), where bacteria from the large intestine migrates to the small intestine and ferment the indigestible components of chyme, and giving off hydrogen, carbon dioxide and methane gas.
How is IBS diagnosed?
As IBS causes no physical changes to the bowel, doctors must rely on patients describing their symptoms. A diagnosis can be made if the patient has been suffering from the typical symptoms for the previous 6 months. However, doctors may wish to carry out tests including blood tests and faeces tests, to rule out other conditions which cause similar symptoms, like inflammatory bowel disease, 1eliac disease or infections.
What are the treatments?
As yet, no cure has been found for IBS, however symptoms can be managed.
One of the easiest treatments is modification of the diet. Dietary advice is best provided by healthcare professionals on an individual basis, based on the patient’s symptoms and reactions to certain foods. Recording a food diary detailing what is eaten and any ill-effects is an effective way of identifying the changes which are needed. Seeking dietary advice may also benefit other aspects of patient health, including ensuring a balanced diet, and weight management.
Fibre, from components of plants like cellulose, lignin and pectin which are resistant to digestive enzymes, is an important factor in the diet. Soluble fibre dissolves in water, causing it to swell and form a gel, softening faeces and stimulating peristalsis. It is though that increasing soluble fibre and water in the diet can ease the symptoms of IBS. In contrast, insoluble fibre acts as an irritant to IBS sufferers as it remains intact during digestion, increasing the speed at which faeces travels through the bowel.
Soluble fibre is found in foods like rice, pasta, oats, root vegetables and fruits including bananas and mangoes. Generally, foods which are stringy, have tough skin or contain seeds are high in insoluble fibre. Specific examples include cereals, wholegrain foods, nuts and seeds, salad and dried fruit. Insoluble fibre should not be completely excluded from the diet but should be consumed in small quantities alongside soluble fibre. Cooking, chopping and pureeing foods containing insoluble fibre may help to reduce their ill-effects.
To reduce flatulence, a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet is recommended. FODMAPs are carbohydrates which are resistant to digestion and as a result, ferment in the bowel. Foods containing FODMAPs include processed wheat products, dairy products containing the sugar lactose, beans and some fruit and green vegetables, including peaches, nectarines, apples, cherries, cabbage, broccoli and peas.
Other ‘trigger foods’ that should be avoided include red meat, dark poultry meat and skin, saturated fats (such as butter and lard), sulphur-rich foods including onions and garlic, acidic foods like vinegar and citrus fruits, fructose (fruit sugar) and artificial sweeteners.
IBS sufferers are advised to eat regularly, avoid skipping meals and take their time whilst eating. Drinking about 2 litres of non-caffeinated, non-alcoholic liquid per day is also recommended.
It is though that probiotic products like yoghurts and capsules may ease IBS symptoms in some patients. It is currently recommended that patients should use a product for 4 weeks before deciding whether it is beneficial. Other suggested ‘off-the-shelf’ products include remedies containing herbs like peppermint, fennel and acacia.
Another effective way to manage IBS, whilst also benefiting other aspects of a patient’s health, like weight management and fitness, is to conduct about 150 minutes of moderate-intensity exercise per week (like cycling and walking). Exercise reduces stress by increasing serotonin levels and also pumps blood away from the bowel and towards other muscles, which may help to ease IBS symptoms both during exercise and in the long-term.
Stress can also be reduced with relaxation techniques such as breathing exercises and meditation and activities like yoga. Other methods to reduce stress or treat IBS-linked depression are counselling, hypnotherapy and Cognitive behavioural therapy (CBT), which teaches people to alter their thinking and behaviour.
Alternative treatments like acupuncture and reflexology are not recommended.
When other treatments fail, doctors may recommend medication. While medication can ease the symptoms of IBS, it may also pose a risk to health due to possible side effects.
Antispasmodics such as Mebeverine are prescribed to relax the bowel muscles thus reducing painful abdominal cramps. For patients with constipation, bulk-forming laxatives, like Normacol or Fybogel, can make bowel movements easier and more regular, due to the insoluble fibre contained within these drugs. In contrast, antimotility medicines such as Loperamine slow peristalsis allowing faeces time to solidify in the bowel, thus easing symptoms for patients with diarrhoea.
Finally, irrespective of whether a patient is displaying psychological symptoms of IBS, antidepressants may be prescribed. Tri-Cyclic Antidepressants (TCAs), like Amitriptyline, interact with neurotransmitters (including serotonin) in the brain where they reduce anxiety and pain, and in the intestines where they slow peristalsis, making them effective for treating patients with diarrhoea. Selective Serotonin Reuptake Inhibitors (SSRIs), like Citalopram, increase serotonin levels in the body, proving them beneficial to patients with constipation.
Is treatment effective?
A study entitled ‘Effects of a health program comprising reassurance, diet management, probiotics administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome’ found that such treatment significantly eased the symptoms of 143 IBS patients who suffered from pain, diarrhoea-dominant IBS or constipation-dominant IBS (as shown in Figure 2). However, this study does not show the individual effect of each treatment.
With regards to probiotics, the NHS argues that little evidence supports their use, however studies such as those cited by probiotic manufacturer OptiBac suggest that their products can be highly efficacious. There is also little evidence to support the use of herbal remedies.
A review of previous studies entitled ‘Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis’ found that antidepressants were 34% more effective than placebo drugs in reducing the symptoms of IBS, while psychological therapies reduced symptoms in 33% of patients. The conclusion stated that both treatments are ‘effective’.
What are the implications treatment?
The ease of availability of information about self-help treatments, (especially on the internet) could be considered unethical as patients may fail to seek professional medical help. The implication is that patients may receive inadequate treatment for their IBS or that other causes of their symptoms may not be diagnosed, which could prove fatal.
The lack of conclusive evidence supporting the use of herbs and probiotics as self-help treatments raises questions as to the ethics of manufacturers promoting such products as they may give rise to ‘false hope’ of a cure.
There are also questions as to the ethics of prescribing medication for a ‘functional’ condition. In addition, social stereotyping could lead to patients prescribed antidepressants being labelled as ‘crazy’ etcetera.
Finally, the treatment of IBS has a significant economic impact on the UK; the National Institute of Health And Care Excellence (NICE) estimate that diagnosis and management of IBS cost the NHS £7,879000 in 2008.
Evaluation of reference materials
Websites like ‘NHS Choices’ and ‘Patient’ provide a useful overview on IBS and cover a wide range of topics, however fail to fully explore many areas including how the different types of fibre affect IBS, why exercise is beneficial to sufferers and how certain drug treatments work.
Despite the ethical issues related to selling untested remedies, of all the references cited, ‘Help for IBS’ provides the most practical advice on changing dietary fibre intake, including food preparation tips. In contrast, other websites like ‘NHS Choices’ purely state that changes should be made. ‘Help for IBS’ also includes information on other ‘trigger foods’, which was not available in the other resources.
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Effect of RF-EMF on Growth of Lepidium Sativum
Table of Contents (Jump to)
CHAPTER 1: INTRODUCTION
1.1 Research Question:
1.2 The Original Experiment
1.3 The Everyday Significance of RF-EMF and Wi-Fi
1.4 Lepidium sativum
1.5 Pilot Study
CHAPTER 2: METHODOLOGY
2.1 Aim of Investigation
CHAPTER 1: INTRODUCTION 1.1 Research Question: How and to what extent do radiofrequency electromagnetic fields (RF-EMF), emitted by Wi-Fi routers, affect the growth of Lepidium Sativum?
1.2 The Original Experiment In February 2013, a group of ninth-grade students from Hjallerup School in Denmark conducted an investigation which arose from the fact that when having their cell-phones switched on and next to them at night, the young researchers struggled to sleep as well as concentrate during school hours.
The students suspected that the radiation emitted by the mobile phones was the cause of the issue, though insufficient resources made it impossible to test accurately their hypothesis. It was found that mobile phones (emitting from 450MHz to 2700MHz) project radiofrequencies (RF) similar to those of house-hold Wi-Fi routers (world-wide band of 2.4 GHz) which hence became a satisfactory substitution in the investigation whilst garden cress (Lepidium sativum) became the remaining test subject. The methodology behind the investigation included that of spreading approximately 4800 cress seeds across twelve trays; six of which were exposed to RF-EMF produced by a Wi-Fi router in one room, whilst the remaining six trays were placed in a room with no radiation. After twelve days of exposure, the first six trays of cress had withered and died, whilst the other 6 flourished, sparking wide controversy and skepticism among “leading biologists and radiation experts”.
It was this experiment that left me questioning whether these results were fair and possible. I decided to conduct a similar experiment under controlled conditions.
1.3 The Everyday Significance of RF-EMF and Wi-Fi According to a recent article on the Huffington Post which featured “50 incredible Wi-Fi Tech Statistics that businesses must know”, it was found that the number of mobile phones exceeded the world’s population at the end of 2013, that in the course of the following three years, seven billion new devices will be “Wi-Fi-enabled” and that mobile devices are used by 38% of 2-year-old infants. Both mobile phones and Wi-Fi enabled devices, such as the average household router, make use of RF-EMF (radiofrequency electromagnetic waves), which have of late been a growing health concern. In fact, the World Health Organization International Agency for Research on Cancer (WHO IARC) deemed EMF as a possible carcinogen in humans in June 2001 at a scientific panel after a connection was found between EMF contact exceeding 4mG and a risk increase of 50% in leukaemia in young children. Other studies also indicate a link between RF exposure and that of male infertility, expressing that “keeping a laptop connected wirelessly to the internet on the lap near the testes may result in decreased male fertility”. The consistent findings from these late studies leave one with an imminent concern for personal safety and investigation.
1.4 Lepidium sativum Lepidium sativum, more commonly known as garden cress or peppergrass, is featured as part of the Brassicaceae family along with many other piquant plants. Salads, soups and sandwiches make use of garden cress and in Europe it is grown industrially; primarily in Scandinavia, the Netherlands, France and Britain.
“The main activity of a plant seedling is growth. During early development, growth is mainly longitudinal, so that a simple measurement of length reveals much about the growth processes. For this reason, plant seedlings have been widely used to study the effects of radiation on growth.” – Henry Quastler, M.D.
The seeds of Lepidium sativum are reddish-tan in colour and reliable during the germination process, during which the cotyledons are divided into three parts. The species is also a reliable choice for experimentation due to its fast growth, in which maximum growth can take anywhere from ten to fourteen days.
1.5 Pilot Study The original experiment carried out by the Danish students featured only six of the trays exposed to RF radiation, next to a Wi-Fi router, while the other six were not. It was speculated by local scientists that the heat emitted by the router may have been the cause of the dead cress. In order for a controlled experiment to be undertaken, the only uncontrolled variable needed to be the RF-EMF themselves since this would be the object of study. I conducted a rough trial of the experiment, a pilot study; to determine the investigations viability.
Small alterations of the original experiment were made, these included: the use of only single trays for each room rather than six and the use of approximately 3000 seeds of Lepidium sativum in each tray and the use of Wi-Fi extenders, rather than routers. The use of Wi-Fi extenders did not compromise the RF that would typically be produced by a router. Furthermore, the extenders were assembled in both rooms, except the Wi-Fi was only switched on in one extender; this made the trial fair due to the fact that equal heat would be emitted from both routers.
Although the Lepidium sativum was fully developed within five to six days, the experimental variable exposed to the Wi-Fi emissions showed that after a full twelve days had withered and died over a large area (see image 1) in comparison to the controlled variable (see image 2). The results of this rough trial were intriguing enough to fully re-investigate the experiment.
CHAPTER 2: METHODOLOGY 2.1 Aim of Investigation The aim of this investigation is to assess how and to what extent do radiofrequencies emitted by Wi-Fi extenders affect the growth of the plant Lepidium sativum from germination to maximum growth by examining daily progression of the seeds in the form of height measurements.
2.2 Hypothesis I predict that the growth of the garden cress in exposure to the Wi-Fi extenders will be inhibited by the radiofrequencies that are produced. This is reasoned by the pilot study carried out prior to this investigation which indicated that the development was negatively affected on a significantly large area of the radiated cress.
2.3 Variables 2.3.1 Constant
Atmospheric pressure (fluctuated due to weather conditions but were consistent with both experimental and control variables at an average of 101.6 kPa)
Temperature at room temperature
Radiofrequency emission at 2.4GHz
Linear growth of Lepidium savitum
 “European Acclaim for Grade 9 Experiment.”DR. N.p., 17 May 2013. Web. 13 Aug. 2014
 World Health Organisation (WHO) http://www.who.int/mediacentre/factsheets/fs193/en/
 “European Acclaim for Grade 9 Experiment.”DR. N.p., 17 May 2013. Web. 13 Aug. 2014