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Where the Spirit Meets the Gut

Gut Health
EuroMedica
 
Kaneka

Treating IBS and IBD with ayurvedic strategies.

Digestive concerns are often one of the classic reasons that bring patients into our clinics each year. Whether from an auto-immune angle, such as ulcerative colitis and Crohn’s disease, or for those with irritable bowel syndrome (IBS) symptoms and non-specific food intolerances, the naturopathic doctor remains one the great allies for patient centered digestive support. The same is true in ayurvedic medicine. In ayurveda, it is said all health begins and ends with the Agni or digestive fire. Without proper Agni, there can be no healthy digestion, and unhealthy digestion will take its toll on the patient in a way that is unique to them and their makeup. So how does the ayurvedic practitioner mirror the naturopathic doctor? They will see the person as unique and treat them and their specific constellation of symptoms. Additionally, they will always be looking for the root of the disease. Perhaps where the two disciplines differ, is what we do when we get to that root. When it comes to ayurveda, the root will always be seen as an inborn vulnerability of one or more of the three primary dosha that make up the human body and govern the entirety of its functions. The three primary dosha known as vata, pitta and kapha, are all strengthened, and weakened by different things. Vata by nature is cold and dry, and promotes the movement of the body, and is nourished by healthy amounts moisture and heat. Kapha is naturally wet and oily, so it thrives best when light foods are given. Lastly, pitta is fiery and hot and promotes transformation, and is best tempered by gentle cooling foods and yoga practices. In ayurveda, like naturopathic medicine, balance is the key to vital living. So what happens when the Agni is harmed, and digestion is impaired? How are IBS and autoimmune IBD (inflammatory bowel disease) understood by the ayurvedic practitioner? And can we find new approaches and methods to support our patients with this information? The answer, as you will see, is yes.

Balancing the Gut/Mind Connection, an Ayurvedic Approach

In ayurveda, the term grahani is most commonly used to describe IBD. It attributes improper eating, drinking, exercising too soon after eating, and either restraining or forcing oneself to do things they may not want to do all as possible etiologies. Ayurveda sees IBD as a primary malfunctioning of the vata dosha within a person. This can happen to anyone of any dosha type but will be most common in those who are considered vata dominant. These are the patients that tend to be thinner, frailer, often taller, and more lithe in appearance. Their personalities are often curious, but more likely to flit from one idea to another. When they are challenged, they will often respond with fear and anxiety as opposed to say frustration or obstinate refusal of an idea or situation. In ayurveda, the vata dosha controls all movement, and is associated with air. This manifests in the IBD patient as uncoordinated bowel movements, being either too many, too few or volleying in between. Furthermore, gas and bloating become very common, and belching is also possible. They believe that toxins from improper digestion are accumulating and blocking the natural movements of the tissues and circulation. This is worsened by those who prefer heavy meals with ice cold fluids and also by those who have a tendency to eat sporadically. It will also be worsened by those who get sick often, which unfortunately, is common in vata types and those with IBD in general.1

In order to harmonize this from an ayurvedic perspective, first detoxification is needed followed by regulation and order, including rescuing the impacted Agni, to help get the vata back into a healthy rhythm. This is achieved by first assessing the patient, looking for places where they are irregular in their life: do they go to sleep at the same time? Do they work erratic hours? Do they skip meals frequently? Are they scared of multiple things potentially happening (be these fears valid or invalid, they impact the vata, which worsens the IBD symptoms)? After assessing for irregularities, the next step is to promote stress reduction though meditation, pranayama breathing practices, prayer, massage and exercise. Then the next step will be to support the detoxification of the ama that has accumulated using an herbal combination known as triphala: a combination of the herbs Terminalia baherica, Terminalia chebula and Emblica officinalis. At first, this may promote increased bowel movements, and the naturopathic doctor should watch and assess if severity becomes unmanageable, but normally there are not any major reactions, and it will lead to the unwinding and resolution of symptoms. Next, warming herbs to stoke the Agni are recommended such a trikatu: a combination of ginger, black pepper and long pepper, along with increasing other culinary spices such as fennel, clove and cardamom. Naturopathic doctors will recognize these as classic carminatives that dispel gas and bloating. Along with this, a switch to fiber rich foods, and those that include probiotics, such as fermented foods (or supplemented probiotics) are necessary to reregulate the bowel. It is likely as the patient improves, their doubts and fears will also improve, but to stay healthy it is vital to educate patients on the ongoing importance of stress management.

Why Do IBS and Other Gut Disorders Flare in the Fall?

Another aspect of treating the gut in ayurveda comes from the fact that ayurveda sees nature within a person, and a person within nature. As such, certain recommendations are given to prevent flare ups. It has been observed in medical literature that GI (gastrointestinal) concerns, especially IBS and IBD, increase in the autumn.2,3 The ayurvedic calendar, which has existed for millennia, states that vata predominates the autumn in nature, where winds blow and things begin to change rapidly. This association with nature and its impact on us cannot be miscounted. Where it becomes useful clinically, however, is in prevention. It is advisable to schedule checkups with your IBS and IBD patients in the late summer or early autumn to assess their overall health and diet, and to give support to lower stress and perhaps even re-teach balance and regularity practices that were offered during the acute phase.

Where the Spirit Meets the Gut

There is much research to support the importance of stress reduction in these populations. Ninety patients diagnosed with IBS using Rome III criteria were randomized to either a mindfulness meditation group or told they had to wait for the next trial. Those who did the meditation practices saw improvements in QOL (quality of life) that lasted up until the end of the six-month follow up period.4 Another trial was performed that looked at patients who had their therapy delivered over the internet, and still found positive results 18 months after discontinuing treatment, and important consideration in the era of tele-health.5 These results have also been duplicated in children, with a small pilot study demonstrating that children felt less stressed, and more able to manage their physical symptoms comfortably.6 Lastly, breathing and meditation workshops were found to not only improve quality of life, but also had a statistically significant drop in HS-CRP in patients as compared to those who were given an educational seminar on IBD.7 This brief demonstration of data should excite the naturopathic doctor and make sure they are checking in on their IBS and IBD patients to make sure their patients are utilizing these critical therapies.

Herbal Strategies

In addition to mind/body as well as nutrition considerations, it is also important to employ herbal medicines, especially during acute symptoms; however, their use in prevention should not be overlooked. Boswellia resins have been studied specifically for prevention of symptoms for those with IBS. After six months of daily use, those in the treatment arm indeed had decreased incidence, and with incidence, severity was less than placebo.8 Similarly, in those with ulcerative colitis, curcumin at 3 g/day was used to induce remission in those with mild-to-moderate disease when used in conjunction with mesalamine as compared to mesalamine alone.9 There has also been a pediatric study of children with IBD to asses for the safety of curcumin when given 500 mg BID for three weeks. The study found there were only two children who reported gas and bloating, otherwise no negative responses were recording. It was also noted that there were improvements in their Pediatric Ulcerative Colitis Activity Index (PUCAI) and Pediatric Crohn’s Disease Activity Index (PCDAI) scores.10 Lastly, a literature review documents the mechanisms and multiple trials that support the many uses of triphala, and specifically for functional GI disorders.11

In Conclusion

Ayurveda is a science of associations and a deep understanding of cause and reaction. By examining some interpretations of ayurvedic wisdom for both IBS and IBD patients, we see that stress, and the management of it, is of primary importance when treating these populations. Additionally, by looking at the individual patient, and their relationship to nature and to themselves, we can make better, nuanced, dietary and lifestyle choices that without a doubt, will help improve our outcomes with these often difficult to treat conditions.

References:

1 Thabane, M., & Marshall, J. K. (2009). Post-infectious irritable bowel syndrome. World Journal of Gastroenterology, 15(29), 3591–3596.

2 Koido, S., Ohkusa, T., Saito, H., Yokoyama, T., Shibuya, T., Sakamoto, N., Uchiyama, K., Arakawa, H., Osada, T., Nagahara, A., Watanabe, S., & Tajiri, H. (2013). Seasonal variations in the onset of ulcerative colitis in Japan. World Journal of Gastroenterology, 19(47), 9063–9068.

3 Dharmaraj, R., Jaber, A., Arora, R., Hagglund, K., & Lyons, H. (2015). Seasonal variations in onset and exacerbation of inflammatory bowel diseases in children. BMC Research Notes, 8, 696.

4 Zernicke, K. A., Campbell, T. S., Blustein, P. K., Fung, T. S., Johnson, J. A., Bacon, S. L., & Carlson, L. E. (2013). Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial. International Journal of Behavioral Medicine, 20(3), 385–396.

5 Ljótsson, B., Hedman, E., Lindfors, P., Hursti, T., Lindefors, N., Andersson, G., & Rück, C. (2011). Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behaviour Research and Therapy, 49(1), 58–61.

6 Arruda, J. M., Bogetz, A. L., Vellanki, S., Wren, A., & Yeh, A. M. (2018). Yoga as adjunct therapy for adolescents with inflammatory bowel disease: A pilot clinical trial. Complementary Therapies in Medicine, 41, 99–104.

7 Gerbarg, P. L., Jacob, V. E., Stevens, L., Bosworth, B. P., Chabouni, F., DeFilippis, E. M., Warren, R., Trivellas, M., Patel, P. V., Webb, C. D., Harbus, M. D., Christos, P. J., Brown, R. P., & Scherl, E. J. (2015). The Effect of Breathing, Movement, and Meditation on Psychological and Physical Symptoms and Inflammatory Biomarkers in Inflammatory Bowel Disease: A Randomized Controlled Trial. Inflammatory Bowel Diseases, 21(12), 2886–2896.

8 Riva, A., Giacomelli, L., Togni, S., Franceschi, F., Eggenhoffner, R., Zuccarini, M. C., & Belcaro, G. (2019). Oral administration of a lecithin-based delivery form of boswellic acids (Casperome) for the prevention of symptoms of irritable bowel syndrome: a randomized clinical study. Minerva Gastroenterologica e Dietologica, 65(1), 30–35.

9 Lang, A., Salomon, N., Wu, J. C., Kopylov, U., Lahat, A., Har-Noy, O., Ching, J. Y., Cheong, P. K., Avidan, B., Gamus, D., Kaimakliotis, I., Eliakim, R., Ng, S. C., & Ben-Horin, S. (2015). Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, 13(8), 1444–9.e1.

10 Suskind, D. L., Wahbeh, G., Burpee, T., Cohen, M., Christie, D., & Weber, W. (2013). Tolerability of curcumin in pediatric inflammatory bowel disease: a forced-dose titration study. Journal of Pediatric Gastroenterology and Nutrition, 56(3), 277–279.

11 Tarasiuk, A., Mosińska, P., & Fichna, J. (2018). Triphala: current applications and new perspectives on the treatment of functional gastrointestinal disorders. Chinese Medicine, 13, 39.

Growing up near the Himalayas, Dr. Shailinder Sodhi developed an early interest in ayurvedic plants and herbs, and received his BAMS (bachelor in ayurvedic medicine and surgery) degree from Dayanand Ayurvedic College in Jalandhar, India in 1985. In 1993, he received a naturopathic medicine degree from Bastyr University, as well as a degree in diagnostic ultrasound from Bellevue College. Dr. Sodhi practices naturopathic medicine along with his wife, Dr. Anju Sodhi, and his brother, Dr. Virender Sodhi, at the Ayurvedic and Naturopathic Medical Clinic in Bellevue, WA, which he established in 1989. In addition, Dr. Sodhi serves as president of Ayush Herbs Inc., a manufacturer of high-quality ayurvedic herbal formulas, is an adjunct faculty member at Bastyr and has been published in several natural health magazines.