Nerd Out: Fibromyalgia Syndrome

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the nervous system. I chose Fibromyalgia as it affects someone close to me and I wanted to find out the various therapeutic modalities and treatment options available.

If you’d like to nerd out with me, continue reading:

Fibromyalgia syndrome (FMS) is characterized by widespread, generalized pain of at least a 3-month duration, affecting an estimated 6-12 million Americans, 80% of whom are women (Kohlstadt, 2012, p. 637; Pizzorno & Murray, 2013, p. 1374; Rakel, 2018, p. 475). Patients with FMS typically experience pain at certain anatomical points on the body, along with extreme fatigue, joint stiffness, headaches, sleep disturbances, irritable bowel, cognitive dysfunction, anxiety, depression, and exercise intolerance, among other symptoms (Pizzorno & Murray, 2013, p. 1375). Although not considered an autoimmune disorder, FMS can coexist and imitate such conditions as Lyme disease, hypothyroidism, and hepatitis C (Rakel, 2018, p. 475). Once considered a result of serotonin deficiency, FMS is now thought to be a disorder of the central nervous system (CNS), specifically neuronal dysregulation (Gota, 2018; Kohlstadt, 2012, p. 637) and a dampening of hypothalamus–pituitary–adrenal reactivity (Gota, 2018). 

There is a strong psychosomatic component to FMS. Symptoms seem to begin with a precipitating stress occurrence or trigger, such as an accident, illness, emotional stress, or trauma (Galvez-Sánchez, Duschek, & Reyes Del Paso, 2019; Rakel, 2018, p. 475). Patients may present with a sensitive personality temperament, inappropriate cortisol response to stress, heightened pain perception (hyperalgesia), and/or a concurrent mood disorder such as anxiety or depression (Bellato et al., 2012; Gota, 2018; Rakel, 2018, p. 475).  

The etiology of FMS isn’t fully understood, though there may be genetic, hormonal, psychiatric, external stressor, neurotransmitter, immune system, and other contributing dysfunctions (Bellato et al., 2012). Obesity, reduced physical activity, hypothyroidism, adrenal dysfunction, irritable bowel syndrome, post-traumatic stress disorder (PTSD), and nonrestorative sleep all are recognized as possible underlying causes (Coppens et al., 2017; Kohlstadt, 2012, p. 642).

Diagnosis of FM can be challenging, as each patient presents with a unique combination of symptoms (Bellato et al., 2012). A thorough patient history including sleep quality, physical activity level, bowel habits, pain perception, fatigue level, menstruation, and cognitive function are key (Pizzorno & Murray, 2013). The ACR Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity, the Pain Distribution Body Form, the FibroQuest Symptoms Survey, and/or the Fibromyalgia Impact Questionnaire may be used to measure the patient’s pain, symptoms, and functional status (Pizzorno & Murray, 2013, p. 1381). 

A physical examination finding abnormal tenderness at 11or more of 18 specific anatomic tender points indicates FMS (Pizzorno & Murray, 2013, p. 1375). The Widespread Pain Index and Symptom Severity Scale also help define the patient’s pain experience (Gota, 2018). A mental health screening, including Zung’s Self-Rating Depression Scale, may provide insight to depression, anxiety, trauma, and PTSD and provide opportunities for referral to mental health specialists (Coppens et al., 2017; Pizzorno & Murray, 2013, p. 1381). 

Laboratory tests include a complete blood count, erythrocyte sedimentation rate, cyclic citrullinated peptide test, rheumatoid factor, antinuclear antibody, Celiac serology, and vitamin D levels, to rule out infection, autoimmune disorders, etc. (Fibromyalgia, 2020). In addition, a thyroid function test and thyroid antibodies test may be ordered to rule out concurrent hypothyroidism (Pizzorno & Murray, 2013, p. 1377). Adrenocorticotropic Hormone test (ACTH), salivary cortisol, Dehydroepiandrosterone Sulfate (DHEA-S), 24-hour urine cortisol, and urinary organic acids (OAT) testing help uncover other possible metabolic, toxic, and infectious contributors to FMS (Kohlstadt, 2012, p. 642). Finally, a colonoscopy and/or stool culture may be ordered to rule out other sources of gastrointestinal discomfort (Kohlstadt, 2012, p. 642).  

Pain relievers, antidepressants, muscle relaxants, and anti-seizure drugs are prescribed most often for FMS. Over the counter non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), are preferred to allay the discomforts associated with FMS (Fibromyalgia, 2020). Acetaminophen (Tylenol) is another widely-used option (Fibromyalgia, 2020). In addition, the analgesic, tramadol, is approved by the FDA specifically to treat pain in FMS (Bellato et al., 2012). Opioids are not recommended due to their significant side effects and dependence (Bellato et al. 2012; Fibromyalgia, 2020). In addition, they have not proven effective in long-term relief, possibly worsening the pain experience over time (Fibromyalgia, 2020). 

Serotonin-norepinephrine reuptake inhibitors (SARIs) such as duloxetine (Cymbalta), milnacipran (Savella), and trazodone (Desyrel), as well as the tricyclic antidepressant/sedative (TCA) amitriptyline (Elavil), are commonly prescribed to help with anxiety and depression associated with FMS (Bilodeau, 2020; Fibromyalgia, 2020; Gota, 2018). Other medications such as the muscle relaxant cyclobenzaprine (Flexeril), the anticonvulsant pregabalin (Lyrica), gabapentin (Neurontin), and/or melatonin are also often prescribed to help with sleep (Bilodeau, 2020; Gota, 2018). Referral to support groups, counseling, and/or therapy may also be part of a traditional FMS treatment plan (National Fibromyalgia Association, 2020).

An integrative approach to FMS includes a focus on nutrition, movement, detoxification, mental health support, and sleep hygiene, minimizing long-term pharmaceutical use (Myers, 2020).  Digestive issues including food intolerances, candida albicans overgrowth, small intestinal bacterial overgrowth (SIBO), leaky gut, irritable bowel syndrome (IBS), and gut dysbiosis are all addressed in a functional treatment plan (Kresser 2019; Myers, 2020). Healing the gut and restoring a healthy gut microbiome is the foundation for healing FMS (Kresser, 2019). 

Removing inflammatory foods, ingredients, and medications such as gluten, sugar, industrial seed oils, dairy, MSG, aspartame, coffee, and when possible, antibiotics, and replacing them with an antiinflammatory diet rich in leafy greens (kale, salad greens, chard, arugula, etc.), cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.), omega-3 fats (salmon, sardines, anchovies, etc.), fermented foods (unsweetened, full-fat yogurt, sauerkraut, kombucha, etc.), fermented fibers (sweet potato, yams, etc.), and bone broth (Kresser, 2019; Rakel, 2018, p. 483) heals the gut and begins restoration of the microbiome. Integration of adaptogenic herbs into the diet such as turmeric, ashwagandha, schisandra, rhodiola, and ginseng aid in balancing the immune system and help to decrease inflammation (Myers, 2020). Finally, nutritional support of the thyroid may be encouraged with consumption of sea vegetables and dulse (Higdon & Drake, 2012, p. 153).

FMS patients often present with deficiencies in magnesium and vitamin D (Myers, 2020). A balance of calcium, magnesium, vitamin D, and vitamin K is crucial to support optimal uptake of all four nutrients (Mercola, 2018). Food sources of magnesium are oats, spinach, beans, nuts, seeds, blackstrap molasses, banana, and avocado (Higdon & Drake, 2012, p. 175; Mercola, 2018). Vitamin D sources are salmon, sardines, and mackerel (Higdon & Drake, 2012, p. 91).  Balanced supplementation is an option when quality food sources aren’t available or tolerated (Higdon & Drake, 2012, p. 175; Mercola, 2018). 

B12 deficiency is also common in FMS patients, and may be the result of age, poor digestion and/or absorption of nutrients, poor diet, or mutation of the MTHFR gene (Kohlstadt, 2012, p. 652; Myers, 2020). Genetic testing may be prescribed by an integrative practitioner. If a mutation is found, supplementation with methylfolate in addition to dietary means (salmon, beef, eggs, chicken, turkey, and nutritional yeast) helps optimize B12 levels (Higdon & Drake, 2012, p. 67-68; Procyk, 2018, p. 101). Healing the gut as mentioned earlier is key to B12 digestions and absorption (Myers, 2020).

Other supplements for FMS may include a high-quality multivitamin, iron, coenzyme Q10, acetyl-L-carnitine, D-ribose, S-adenosylmethionine, boswellia, N-acetyl choline, milk thistle, alpha lipoic acid, and/or St. John’s wort (Kohlsdadt, 2012, p. 652; Myers, 2020; Rakel, 2018, p. 479).

In addition to the laboratory tests mentioned above, functional medicine practitioners may also order an intestinal barrier function test to evaluate the mucosal lining of the intestines, and/or a comprehensive stool assessment to check for parasites and bacterial infections (Grisanti, 2015). Heavy metals testing with a pre- and post- DMPS urine challenge reveals heavy metal burden and indicates any need for chelation therapy (Myers, 2020). Celiac serology confirms sensitivity or allergy to gluten (Fibromyalgia, 2020).

Finally, positive lifestyle habits are encouraged in the integrative treatment of FMS. Exercise has been shown to ease the pain of FMS patients (Bellato et al., 2020; Mercola, 2010). Starting with just a few minutes a day working up to at least 30, a combination of weight-bearing, aerobic, and strength training activities bring the best benefit (Pizzorno & Murray, 2013, p. 1382; Rakel, 2018, p. 483). Sleep hygiene is addressed, optimizing the sleep environment, quality, and duration (Chetlin & Landis, 2020). Stress, anxiety, and/or depression are managed through psychotherapy, cognitive behavioral therapy, emotional freedom technique tapping (EFT), meditation, journaling, art, etc. (Michalsen et al., 2013; Rakel, 2018, p. 482). Lastly, various forms of fasting have been shown to help with inflammation and pain management (Michalsen et al., 2013).







References

Bilodeau, K. (2020, September 15). Getting the best treatment for your fibromyalgia. Retrieved November 16, 2020, from https://www.health.harvard.edu/blog/getting-the-best-treatment-for-your-fibromyalgia-2020091020905

Bellato, E., Marini, E., Castoldi, F., Barbasetti, N., Mattei, L., Bonasia, D., & Blonna, D. (2012). Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Retrieved November 03, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503476/

Chetlin, S. M., & Landis, C. (Eds.). (2020, September 28). Fibromyalgia & Sleep. Retrieved November 19, 2020, from https://www.sleepfoundation.org/articles/fibromyalgia-and-sleep

Coppens, E., Van Wambeke, P., Morlion, B., Weltens, N., Giao Ly, H., Tack, J., . . . Van Oudenhove, L. (2017, May 24). Prevalence and impact of childhood adversities and post‐traumatic stress disorder in women with fibromyalgia and chronic widespread pain. Retrieved November 09, 2020, from https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1059

Fibromyalgia. (2020, October 07). Retrieved November 09, 2020, from https://www.mayoclinic.org/diseases-conditions/fibromyalgia/diagnosis-treatment/drc-20354785

Galvez-Sánchez, C., Duschek, S., & Reyes Del Paso, G. (2019, February 13). Psychological impact of fibromyalgia: Current perspectives. Retrieved November 03, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386210/

Grisanti, R. (2015, January 31). Fibromyalgia Who Told You There Wasn't A Cure? Retrieved November 18, 2020, from https://www.functionalmedicineuniversity.com/public/986.cfm

Gota, C. (2018, May 01). What you can do for your fibromyalgia patient. Retrieved November 03, 2020, from https://www.ccjm.org/content/85/5/367

Higdon, J., & Drake, V. J. (2012). An evidence-based approach to vitamins and minerals health benefits and intake recommendations (2nd ed.). Stuttgart, Germany: Thieme.

Kohlstadt, I. (2012). Advancing medicine with food and nutrients. Boca Raton, FL: CRC Press, Taylor & Francis Group.

Kresser, C. (2019, June 18). Is Fibromyalgia Caused By SIBO and Leaky Gut? Retrieved November 16, 2020, from https://chriskresser.com/is-fibromyalgia-caused-by-sibo-and-leaky-gut/

Mercola, J. (2010, January 19). Foods to Avoid by Patients Dealing with Chronic Pain. Retrieved November 18, 2020, from https://articles.mercola.com/sites/articles/archive/2010/01/19/foods-that-chronic-pain-sufferers-need-to-avoid.aspx

Mercola, J. (2018, March 21). Magnesium: An Invisible Deficiency That Could Be Harming Your Health. Retrieved November 16, 2020, from https://www.prohealth.com/library/magnesium-an-invisible-deficiency-that-could-be-harming-your-health-34192

Michalsen, A., Li, C., Kaiser, K., Lüdtke, R., Meier, L., Stange, R., & Kessler, C. (2013, January 23). In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy. Retrieved November 18, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566607/

Myers, A. (2020, September 15). Fibromyalgia - A Functional Medicine Approach. Retrieved November 03, 2020, from https://www.amymyersmd.com/article/fibromyalgia-functional-medicine/

National Fibromyalgia Association. (2020, November 10). Retrieved November 16, 2020, from https://fmaware.net/

Pizzorno, J. E., & Murray, M. T. (2013). Textbook of natural medicine. St. Louis, MO: Elsevier.

Procyk, A. (2018). Nutritional treatments to improve mental health disorders: Non-pharmaceutical intervention for depression, anxiety, bipolar & ADHD. Eau Claire, WI: Pesi Publishing & Media.

Rakel, D. (2018). Integrative Medicine. Philadelphia, PA: Elsevier Health Science.

Nerd Out: Irritable Bowel Syndrome

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a gastrointestinal disorder. I chose Irritable Bowel Syndrome, as it ranks up there as one of the most prevalent chronic disorders people experience. If you’d like to nerd out with me, continue reading:

Irritable Bowel Syndrome, or IBS, is defined as chronic inflammation of the large intestine and presents itself through a cluster of symptoms, including abdominal pain, spasms, bloating, gas, and abnormal bowel movements (Lipski, 2012, p.286). Because there is a spectrum within the symptoms (mild to severe), and because the symptoms fluctuate over time, it is often challenging to differentiate between IBS and normal variations of the gastrointestinal tract (Rakel, 2018, p.423). Stress has proven to play an integral part in the flare-up of IBS, providing a psychosocial perspective to treatment (Rakel, 2018, p.423), although some experts prefer to categorize it as a disorder of the gut-brain axis rather than as a psychiatric disorder (Kohlstadt, 2012, 261). A diagnosis is made due to its chronic nature (at least 6 months’ duration) (Kohlstadt, 2012, p.261), by excluding pathology, and including some or all of the symptoms of abdominal pain/discomfort, bloating, and diarrhea/constipation (Rakel, 2018, p.423).

Specifically, the Rome III Criteria for Irritable Bowel Syndrome defines IBS as at symptoms lasting at least three months, with onset at least six months previously of recurrent abdominal pain or discomfort associated with two or more of the following: Improvement with defecation; Onset associated with a change in frequency of stool; And/or onset associated with a change in form (appearance) of stool (Kohlstadt, 2012, p.262). This, with the absence of weight loss, anemia, and rectal bleeding, support the diagnosis of IBS (Kohlstadt, 2012, p.261).

Also prevalent amidst the cluster of symptoms may be nausea, anorexia, hypersecretion of colonic mucus, restless leg syndrome, migraine headaches, chronic fatigue, irritable bladder, and dyspareunia (Pizzorno & Murray, 2013, p.1557). IBS is often seen in patients with a history of sexual abuse and/or sexual dysfunction, fibromyalgia, urinary frequency and urgency, poor sleep, menstrual difficulties, lower back pain, and insomnia (Pizzorno & Murray, 2013, p.1557).

IBS is cited as the most common GI disorder seen in general practice, representing 30%-50% of all referrals to gastroenterologists (Pizzorno & Murray, 2013, p.1557). Women are diagnosed twice as often as men, which might be due to men under-reporting symptoms (Pizzorno & Murray, 2013, p.1557), and is more prevalent in Caucasian persons than others. Early studies demonstrate that IBS patients tend to have an enhanced stress responsiveness that presents higher morning cortisol levels and an inability to turn off the stress response, both which have been shown to increase intestinal permeability and inflammation (Rakel, 2018, p.429).  

There are three subgroups of IBS under which patients are categorized: constipation predominant (IBS-C), diarrhea predominant (IBS-D), or mixed (IBS-M) (Kohlstadt, 2012, p.261).  Risk factors may be environmental, genetic, or both (Kohlstadt, 2012, p.262). Several conditions, including food allergies, infections, poor diet, and metabolic disorders mimic the symptoms of IBS and must be ruled out in order to make the diagnosis.

The etiology of IBS is unclear, although it frequently occurs in concert with Small Intestinal Bacterial Overgrowth (SIBO) and Leaky Gut Syndrome (Lipski, 2012, p.287). IBS can also be caused by stressors to the gut as mentioned above, leading to an over-active inflammatory response in the mucosal tissue of the large intestine (Lipski, 2012, p.288). Parasites and candida overgrowth may also play a role in IBS, and women may experience increased symptoms around their menstrual periods (Lipski, 2012, p.288). Chronic stress, dysregulated immune response, dysbiosis, overconsumption of alcoholic beverages, certain medications such as NSAIDs and birth control pills, and even lectins have been implicated in the chronic inflammation characteristic of IBS (Lipski, 2012, p. 46-47) (Rakel, 2018, p.423).

Allopathic approaches to IBS focus on three main therapies: increasing fiber in diet, probiotics, and antibiotic therapy (Rifaxamin), especially if SIBO is indicated (Lipski, 2012, p.287) (Rakel, 2018, p.430). Another pharmaceutical, oral Cromolyn (brand name Gastrocrom), is used to control the release of GI-irritating substances from mast cells in the GI tract (https://www.mayoclinic.org/drugs-supplements/cromolyn-oral-route/description/drg-20063181).  And with the mind-body connection to IBS, tricyclic antidepressants and selective serotonin reuptake inhibitors are an option for patients with IBS-D (Rakel, 2018, p.430).

For IBS-C, a diet high in fiber (25-30 grams per day, preferably insoluble fiber such as in oats and psyllium), and low in fat help with stool bulking and intestinal motility (Kohlstadt, 2012, p.272).  Pharmaceuticals such as 5-hydroxytryptophan (5-HTP), Lubiprostone, Tegaserod, and Renzapride may be indicated soften the stool and relax the gut. (Kohlstadt, 2012, p.265) (Pizzorno & Murray, 2013, p.1560).

Anticholinergic agents are used to reduce abdominal cramping and smooth muscle spasms (Kohlstadt, 2012, p.266). Peppermint oil is gaining traction in the allopathic medical community as another option for relaxation of the smooth muscle in the GI tract as well as for mediation of other symptoms (Kohlstadt, 2012, p.266) (Pizzorno & Murray, 2013, p.1560).

Broad-spectrum probiotics are recommended to repopulate the intestinal microbiome with optimal rather than pathogenic gut microflora, decrease fermentation, and stimulate proper immune function (Rakel, 2018, p.427) (Pizzorno & Murray, 2013, p.1559).

Antibiotic therapy, specifically Rifaxamin, has been found to significantly improve IBS symptoms, especially in IBS-D patients and those with comorbid SIBO (Rakel, 2018, p.430).

All types of IBS may benefit from Cognitive Behavioral Therapy and/or hypnotherapy to help with accompanying anxiety and depression (Kohlstadt, 2012, p.271).

The above-mentioned approaches are based on an extensive medical history, including frequency of abdominal pains, gas, bloating, constipation, and/or diarrhea. Lab tests may include a comprehensive stool analysis, complete blood count, erythrocyte sedimentation rate, free thyroid T3 hormone levels, and antiendomysial antibody testing for celiac disease (Pizzorno & Murray, 2013, p.1557).  The enzyme-linked immunosorbent assay (ELISA) allergen challenge test or the ELISA IgE/IgG4 test are sometimes used to detect food allergies (Pizzorno & Murray, 2013, p.1558).

IBS-D type symptoms may indicate a panendoscopy with duodena, colonic, and terminal ileal biopsies to rule out celiac disease, inflammatory bowel disease, and colitis (Pizzorno & Murray, 2013, p.1557). Additional stool testing for eosinophilic cationic proteins may be indicated if food allergy is suspected (Pizzorno & Murray, 2013, p.1557). Finally, screening for occult fecal blood, flexible sigmoidoscopy/colonoscopy are also options to rule out other causes (Pizzorno & Murray, 2013, p.1557).

Integrative approaches take a broader approach to diagnosis and treatment. Assessments such as a health history questionnaire are combined with a comprehensive discussion and/or physical assessment, and include all of the inclusions and exclusions as a diagnostic tool as listed previously. Family medical history is noted, as there may be a genetic link (Rakel, 2018, p.423). A food journal and dietary history is collected to detect possible food sensitivities, intolerances, and allergies (Lipski, 2012, p.288-289), as well as helps determine detrimental dietary choices and eating patterns.

Breath tests, including the SIBO breath test (or the Hydrogen-Methane test), the Lactose-Intolerance/Lactose Malabsorption test, the Fructose Intolerance/Fructose Malabsorption test, and/or the Sucrose Intolerance/Sucrose Malabsorption test are utilized to detect gut sensitivities to sugars, and are especially indicated if leaky gut or SIBO are suspected (What is Irritable Bowel Syndrome, 2019, https://www.commdx.com/)  (Lipski, 2012, p.289) (Kohlstadt, 2012, p.272). Organic acid testing is also a possibility, providing an evaluation of intestinal yeast and bacteria (Lipski, 2012, p.289), and an HCl challenge test can detect decreased gastric acid production (Rakel, 2018, p.430).

Permeability, or leaky gut issues can also be assessed using a lactulose-mannitol urine test or with positive IgG food antibody testing (Rakel, 2018, p.423).

A comprehensive digestive stool analysis including parasitology is recommended, as candida overgrowth and parasites are often overlooked causes of IBS (Lipski, 2012, p.288).

An elimination diet and subsequent food challenge helps identify triggering foods (Rakel, 2018, p.426). Introducing therapeutic dietary systems (FODMaPs/fermentable carbohydrates avoidance, GAPS, Paleo, low-sugar, dairy-free, gluten-free, lectin-free, caffeine-free, alcohol-free, etc.), based on individual needs often provides symptomatic relief (Pizzorno & Murray, 2013, p.1558, 1559) (Lipski, 2012, p.289) (Rakel, 2018, p.426) (Kohlstadt, 2012, p.269). It is important to note that artificial sweeteners such as sorbitol, maltitol, or xylitol may worsen bloating and diarrhea in IBS patients so should be avoided (Kohlstadt, 2012, p.270-271).

Increasing fiber with psyllium seeds, flaxseed, or hemp seed is recommended, as well as adding a broad-spectrum probiotic that includes lactobacilli and bifidobacteria (Lipski, 2012, p.290). Eliminating dairy foods, sugar, fruit, honey, and maple syrup may ease symptoms (Lipski, 2012, p.289, 290). Prebiotic-rich foods (bananas, artichokes, garlic, onions, etc.) as well as probiotic foods (sauerkraut, kimchee, and kvass, etc.) stimulate and feed healthy GI flora (Rakel, 2018, p.428) (Axe, 2018, https://draxe.com/leaky-gut-diet-treatment/).

Other dietary supplements include pancreatic enzymes, ginger, aloe, Chinese herbs such as Padma Lax and STW-5, glutamine, EPA/DHA fish oil, peppermint oil, chamomile, rosemary, Melissa (balm), valerian, betaine hydrochloride, and calcium-magnesium citrate (Rakel, 2018, p.428- 430) (Lipski, 2012, p.290-291).

Bone broth soothes the gut and provides the nutrients collagen, glycine, proline, and glutamine, as well as easily absorbable minerals and natural anti-inflammatories like chondroitin sulfate and glucosamine (Kresser, 2019, https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/).

Decreasing the chemical load by eating organic produce, and pastured eggs and meat, allows for optimal healing of the gut. Other nutrient-rich foods include healthy fats like coconut oil, avocado, and the omega-3 fats in fatty fish. Sprouted seeds, fermented vegetables, and adequate hydration round out the list (Axe, 2018, https://draxe.com/leaky-gut-diet-treatment/)

Finally, lifestyle modifications that include more self-care to decrease stress, anxiety, and depression have been shown to decrease IBS symptoms. Mind-body therapies include stress management, relaxation therapy, meditation, hypnosis, journaling, biofeedback, art therapy, acupuncture, and gentle exercise such as yoga, and walking (Rakel, 2018, p.429). Often more effective than medical therapy (Rakel, 2018, p.429), stress reduction strategies tap into the mind-body and gut-brain connection that affects both sickness and wellness. An entire paper could be written on this topic as well, but suffice it to say, a holistic approach to Irritable Bowel Syndrome, including diet, supplementation, exercise, and stress reduction, offers promise to provide not just physical but emotional relief as well.   

References

Axe, J. (2018, July 30). Leaky Gut Diet and Treatment Plan, Including Top Gut Foods. Retrieved May 30, 2019, from https://draxe.com/leaky-gut-diet-treatment/

Cromolyn (Oral Route) Description and Brand Names. (2019, February 01). Retrieved May 30, 2019, from https://www.mayoclinic.org/drugs-supplements/cromolyn-oral-route/description/drg-20063181

Kohlstadt, I. (Ed.). (2012). Advancing medicine with food and nutrients. Boca Raton: CRC Press.

Kresser, C. (2019, May 28). Bone Broth Benefits: Everything You Need to Know. Retrieved May 30, 2019, from https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/

Lipski, E. (2012). Digestive wellness: Strengthen the immune system and prevent disease through healthy digestion. New York, NY: McGraw-Hill.

Pizzorno, J., & Murray, M. T. (2013). Textbook of natural medicine. St. Louis, MO: Elsevier.

Rakel, D. (2018). Integrative medicine. Philadelphia, PA: Elsevier.

What is Irritable Bowel Syndrome? (2019). Retrieved May 31, 2019, from https://www.commdx.com/