I hope you can share this with your readers and perhaps improve the quality of life of someone out there. It has been wonderful for me.

DEAR READER: IBS is a malfunction of motility of the colon. Stress, medications, specific foods, caffeine, alcohol and gas contribute to symptoms that include abdominal pain, flatulence and diarrhea/constipation. The medication you have been prescribed can cause identical symptoms.

Colesevelam (WelChol) reduces the amount of cholesterol and specific fatty substances in the blood. It is sometimes prescribed with other cholesterol-lowering statin drugs toward this goal. This drug binds bile acids in the intestines to form a product that is ultimately released from the body. It is also prescribed for some type 2 diabetics to control blood-sugar levels. Drugs that have been manufactured and marketed for one purpose are often used for other, seemingly unrelated conditions and work well. My guess is that the reduction of fatty substances in your colon curbed your diarrhea and related symptoms. Or you are less stressed, have modified your diet or medications, and have taken other steps without realizing the positive impact they have had.

To provide related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

IBS is described as a ‘functional’ illness — the small and large intestines are not functioning appropriately although there is no structural damage found through diagnostic testing. No anatomic defect can be found in IBS patients, and the cause of the illness is not known. What is known is that there is a link between the onset of symptoms and emotional triggers. There are two major clinical types of IBS described in Western medicine: diarrhea-predominant IBS and constipation-predominant IBS. Diarrhea-predominant IBS is characterized by diarrhea, which occurs immediately after waking up or immediately after eating. Other common symptoms include pain, bloating, urgency, and urinary incontinence. Constipation-predominant (or ‘spastic colon’ type) IBS manifests with pain over at least one area of the colon and periodic constipation. This pain may be continuous or it may come in bouts, and is frequently relieved by moving the bowels. There may be constipation alternating with normal stools or constipation alternating with diarrhea. The stool often contains mucus. Associated symptoms include bloating, gas, nausea and dyspepsia. Eating can commonly trigger these symptoms. Western medicine treats IBS with anti-spasmodic or anti-diarrhea medication, diet modification and stress reduction techniques.

Traditional Chinese Medicine (TCM) is a medical system which combines the use of acupuncture, Chinese herbs, and nutrition to bring the body into balance. Whereas Western medicine looks closely at a symptom and tries to find an underlying cause, TCM looks at the body as a whole. Each symptom is looked at in relationship to all other presenting symptoms. The goal of the TCM practitioner is to assess the entire constitution of the patient — considering both physiological and psychological aspects. The practitioner first observes the general characteristics of the patient, and then tries to discern a relationship between symptoms in order to establish what is called a “pattern of disharmony.”

To look at the body as an integrated whole, one also looks at the theory of the ‘Internal Organs.’ The TCM definition of an Internal Organ is very different from the Western concept. In Western medicine, an organ is a material-anatomical structure. In Chinese medicine, each Internal Organ encompasses much more. There can be an anatomical structure, but there is also a corresponding emotion, tissue, sensory organ, color, and element. In addition, twelve of the Internal Organs correspond to the twelve main acupuncture meridians that run through the body. There is energy (Qi) flowing through each meridian. If an Internal Organ is out of balance, the energy of that organ will be damaged. IBS affects the large and small intestines in Western medicine, but in Chinese theory, the Spleen, Liver, Kidney, and Large Intestine can all play a role in the pattern of disharmony.

In TCM, the Spleen is considered to be the key organ to regulate digestion. Keep in mind; this is not the same as the Western spleen. Its functions actually have a closer connection to the Western pancreas. IBS patients with a pattern of Spleen Qi deficiency will suffer from fatigue and diarrhea, which becomes worse when they are overexerting themselves. This is often accompanied by abdominal pain, which may be relieved by exerting pressure over the painful area. Patients may also have gas and bloating. Hemorrhoids are an additional indication of Spleen Qi deficiency. Acupuncture points are chosen which will help nourish the Spleen Qi. There are also specific techniques used in needling that strengthen the body when the patient is deficient. Another important part of treatment is the Chinese herbal formula. In Chinese herbalism, a group of herbs is combined together to specifically address a person’s unique constitution. This is one way in which treatment is very individualized — a master herbalist treats no two patients with the same combination of herbs. Most herbalists use a “classical formula” as a foundation. Many classical formulas written up to 2,000 years ago are still commonly used today. Groups of herbs can be added or taken out of classical formulas on order to customize them for patients. One classical formula used for Spleen Qi deficiency is called Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination). By adding and subtracting herbs from this formula, it can be individualized to fit the precise needs of the patient.

Another pattern is Spleen Distressed by Dampness. In this pattern the patient may experience symptoms of nausea or heaviness. Bowel movements may feel incomplete, or the patient may even have constipation lined with mucus. This condition is often caused by eating too much fried or greasy food, but may also be caused by emotional factors such as over-thinking or over-worrying. Acupuncture points are chosen to nourish the Spleen and eliminate dampness. The classical herbal formula to address this pattern is called Shen Ling Bai Zhu San (Ginseng, Poria & Atractylodes Powder). Patients are additionally advised to keep a very clean diet. In Chinese medicine, dairy foods and excessive sugar intake create dampness, so these foods should be avoided altogether.

Other patterns include “Cold in the Spleen”, “Spleen and Kidney Yang Deficiency”, “Liver Qi Stagnation”, and “Damp-Heat in the Large Intestine”,

Irritable Bowel Syndrome is clearly a complicated illness in both Western and Chinese medicine. Its many manifestations require very different treatment approaches in Traditional Chinese Medicine. The patterns of disharmony mentioned above may even appear in combination and treatment must be adjusted appropriately. In any severe case of IBS, TCM treatment will be customized for the individual and classical herbal formulas will be modified for the patient.

An Australian study published in 1998 in the Journal of the American Medical Association lends strong scientific support to treating IBS with Chinese herbs. In this double-blind study, 116 patients with IBS were divided into three groups. One group was given a standard Chinese herbal preparation, a second group was given customized herbal formulas individually written for each patient, and a third group was given a placebo. Each patient had regular consultations with both a Chinese herbal-medicine practitioner and a gastroenterologist. Both groups taking the Chinese herbs showed significant improvement over the patients taking the placebo. Positive results were reported by both the patients themselves and the gastroenterologists. Although there was improvement in both groups of patients taking herbs, it is important to note that the positive effects were shown to last longer in the group that was given individualized formulas. This study clearly shows that Chinese herbalism is most effective when each patient is treated not only for their condition, but also for their bodily constitution and other presenting symptoms.

Alan Rivenson, L.Ac., Dipl. Ac.
Affordable Acupuncture
PO Box 298, Canaan, CT 06018
860-824-7727
ARivenson@att.net
www.BerkshireQi.com

I was diagnosed with irritable bowel syndrome several years ago and I frequently have to urinate.

I didn’t realize the use of Excedrin was so bad until recently. I have completely stopped using it but now wonder if the damage is reversible. Is there anything I can do to make my kidneys healthier?

DEAR READER:
Let me start by saying, a normal blood urea nitrogen (BUN) level ranges between 8 and 20. In my opinion, your level of 21, while technically abnormal, is insignificant. It is not abnormal enough to be diagnostic of kidney damage. This does not mean you do not have some degree of damage.

Over use of any medications can potentially lead to kidney damage because they are all processed within the kidney before being excreted in the urine. That is why most physicians urge patients to use medication only when and if needed, especially over-the-counters.

If you are still concerned, I recommend you make an appointment to speak with your primary physician who can explain the results and what they may mean. He or she may choose to order other tests, such as a kidney ultrasound, to determine if there is any damage and if so, the severity.

To give you related information, I am sending you a copy of my Health Report “Kidney Disorders”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Recently, I started feeling tired and run down after normal activity. I consulted my medical doctor who ordered a colonoscopy and blood testing. The results of the colonoscopy were negative. Blood tests indicated my red blood count was four, so I’ve been taking iron pills for three months. It is still four. Where do I go from here?

DEAR READER:
A red blood cell count of four is hardly abnormal. I don’t believe you are suffering the symptoms of anemia.

When did the constipation and fatigue start? Do they coincide? Have you been diagnosed as having Irritable Bowel Syndrome (IBS) with constipation? (I would also like to add that having one bowel movement a month is a near physical impossibility, especially when taking Zelnorm, a drug used for the short-term treatment of IBS with constipation and milk of magnesia.)

Zelnorm shows improvement in most individuals who take it but can cause diarrhea. Milk of magnesia encourages evacuation. It seems to me that when taking both these medications, you would hardly be able to leave the house for fear of constant diarrhea. It also suggests that you may have an intestinal abnormality causing obstruction or a similar disorder.

You need to be seen by a gastroenterologist. I believe your symptoms are related to your chronic constipation. If the gastroenterologist determines there is no physical reason for the constipation and believes the fatigue is from your very slight anemia, you may wish to see a hematologist (blood specialist) for further evaluation.

To give you related information, I am sending you copies of my Health Reports “Irritable Bowel Syndrome” and “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I have tried your “Certo with grape juice” remedy for arthritis. Sadly it didn’t work for me. However, in today’s column, a patient wrote in telling you how it helped her IBS. Then it dawned on me that you’re supposed to DRINK the stuff, not rub it on your joints. Which, by the way, is what I was doing and it is very messy!

Just thought you might like to know that you have to “spell it out” for some of us! I am going to try again and I hope to get better results this time. Thanks!

DEAR READER:
Several readers have sent me letters touting the value of Certo and grape juice in helping reduce the discomfort of irritable bowel syndrome. This was certainly news to me. Remember that the combination should be swallowed, not simply rubbed in over a painful joint.

If you want a product that you can rub into the joint, rather than drinking, I recommend using castor oil or Castiva. Castiva is a cream that contains castor oil base and comes in warming and cooling formulas. Castor oil is rubbed onto the affect joint(s) twice a day. The Castiva can be used as often as needed.

Certo is liquid pectin. Brand does not seem to make a difference in effectiveness. It is found in the baking section of many grocery stores. Castor oil can be purchased at most pharmacies. Castiva is available at Wal-Mart, Walgreens, CVS, Rite-Aid, or online at www.CastivaBrands.com.

To give you related information, I am sending you copies of my Health Reports “Understanding Osteoarthritis” and “Dr. Gott’s Compelling Home Remedies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READER: Colonic irrigation is unnecessary and should be avoided.

If you have chronic constipation, you should be examined by your primary care physician or a gastroenterologist. He or she can examine you to ensure there is no physical cause, such as blockage or polyps. You should then be checked for irritable bowel syndrome which can manifest itself as chronic diarrhea or constipation or a combination of both. Depending on the cause, you can then discuss treatment options such as bulking up with fiber, the use of stool softeners or perhaps you need medication.

You should stop using the enema bag. It is most likely worsening the situation and can lead to nutritional deficiency if used frequently.

To give you related information, I am sending you copies of my Health Reports “Constipation and Diarrhea” and “Irritable Bowel Syndrome”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I didn’t start this way of eating until four months ago, because I didn’t think I could give up cheese and yogurt (which I didn’t really have to because there are so many delicious soy substitutes out there now). I started avoiding trigger foods and now I’m 95% better. I can actually leave my house without fear and dread of an attack. I’ve lost the big bloated stomach that wouldn’t go away no matter how little I ate.

I hope this will help. Spastic colon is a horrible and embarrassing affliction to endure.

DEAR READER: Thank you for sharing the information about “trigger foods”. If they can be avoided — leading to a lessening of IBS attacks — I’m in favor of recommending a trial period for those readers who wish to try the diet. Let me know if trigger foods really do reduce the pain and bloating.

To give you related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome”. Other readers who would like a copy should send a long, self-addressed, 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.