More Steps Per Day Associated with Milder Irritable Bowel Symptoms

The association between emotions, the brain and the intestines has always been of great interest to me. As a young medical student facing the stress of having to succeed academically, I developed irritable bowel syndrome. I have written previously about my encounters with IBS and discussed how my symptoms diminished as my coping skills improved. I have always loved to aerobically exercise for stress reduction but never really appreciated how that activity may have diminished my irritable bowel discomfort.

Toyohiro Hamaguchi, PhD, of the School of Health Sciences at Saitama Prefectural University reported on a study discussed in Plos One showing that with increased walking irritable bowel symptoms seemed to diminish. The study looked at 100 students, 78 of whom were women with a mean age of 20 years old. They were recruited for the study based on their diagnosis of irritable bowel syndrome between the years 2015-2018.

The participants were not obese based on Body Mass Index (BMI). They answered a GSRS (Gastrointestinal Symptom Rating Scale) document at the start of the study and again while participating in the study. The rating scale evaluates the severity of abdominal pain, indigestion, reflux, diarrhea and constipation. Walking patterns were then tracked using a pedometer.

They found that with increasing daily steps, the severity of the symptoms markedly decreased based on the GSRS rating scale. Based on their findings, the severity of symptoms decreases by 50% when increasing your daily step count from 4000 steps to greater than 9500.

Dr. Hamaguchi explained that “mild physical activity helps clear intestinal gas and reduces bloating. Thirty minutes of daily walking is recommended for increasing colon transit time in adults with chronic constipation. Recent research has found that inflammatory biomarkers were reduced after 24 weeks of moderate -intensity aerobic exercise”.

This is one more study showing that low to moderate intensity exercise, on a regular basis, allows you to feel better. During this Covid19 Pandemic the stress level for all is so much higher. Take a 30-minute walk at your own pace, maintaining social distancing and with a mask available if someone starts to get close . It will reduce your stress and improve your health!

Extreme Exercise Tied to Gut Damage

I was out doing my morning two mile trot on an unseasonably cool late spring morning in South Florida. The crispness of the day, coupled with unexplained lack of my normal warm up aches and pains made me particularly frisky. I had walked the dog for a few miles slowly, then engaged in my normal pre-run stretching routine and felt unusually energetic and fluid. I was enjoying the outdoors and weather, while listening to music on my play list and struggling to stay within the parameters of speed, pace, and target heart rate appropriate for a 67 year old man. The inner competitor within me was screaming, “You feel great, go for it.” Moderation and common sense are always the great traits to keep exercising and not injured. The inner stupid competitor in me said pick up the pace. I did pick up the pace. I completed my course far quicker than usual. I performed my cool down and stretching routine and was feeling pretty cocky about doing more than I should when I heard that rumble in my gut and saw the distention begin. The distention was followed by cramps, gas and profuse uncomfortable loose stools for several hours. My gut was sore and my appetite was gone.

I mention this after reading an article review in MedPage Today about a publication in the journal Alimentary Pharmacology and Therapeutics published by Ricardo J.S. Costa, M.D., of Monash University in Victoria, Australia. He and his colleagues showed that exercise intensity was a main regulator of gastric emptying rate. Higher intensity meant causing more disturbances in gastric motility. High intensity exercise at a rate you are not used to for a period of time longer than you usually exercise leads to gut problems including all the issues I experienced. Low to moderate physical activity was found to be beneficial especially to patients, like myself, suffering over the years from irritable bowel syndrome.

The researchers found that ultra- endurance athletes competing in hot ambient temperatures running in multi stage continuous 24 hour marathons were far more likely to develop exercise associated GI symptoms than individuals running a less intense half marathon. The results are fairly clear for us non ultra-endurance athletes. There is great wisdom in regular moderate exercise to keep your effort within the parameters your physician and trainer recommend based on your age and physical training. Even if it’s a cool crisp day and you feel that extra surge of adrenaline and competitiveness, moderation is best for your health and your gut. I hope the competitor in me remembers that the next time the urge to push the limit pops up.

A Blood Test for Irritable Bowel Syndrome?

Researchers presented a paper at the annual Digestive Disease Week meeting which introduced a commercial blood test which can help distinguish irritable bowel syndrome (IBS) from Cohn’s Disease or Ulcerative Colitis (Inflammatory Bowel Diseases) and Celiac Disease ( Gluten Sensitive Enteropathy). The test was especially effective in identifying the diarrhea predominant form of Irritable bowel syndrome. The issue was discussed today on line in the periodical MedPage Today.

Patients with Irritable Bowel Syndrome get sudden abdominal bloating, cramping and progressively watery loose bowel movements. The symptoms often occur after a meal and leave the patient frightened and exhausted. Symptoms can be prolonged and emotionally and physically incapacitate an individual. Until now physicians were forced to schedule barium enemas, small bowel x ray series and fiber optic examinations (sigmoidoscopies, colonoscopies, upper endoscopies) to distinguish irritable bowel syndrome from the more ominous inflammatory bowel diseases. Very often we needed to collect stool specimens to look for white blood cells, red blood cells, bacteria, parasites and chemical constituents. The cost, radiation exposure and risks of invasive procedures causing complications made the experience expensive and unpleasant but necessary.

The current blood tests, used in a trial of 2700 patients, detect antibodies to cytolethal distending toxin B and vinculin. Mark Pimental, MD of Cedars-Sinai Medic al Center in Los Angeles said to the tests were successful in distinguishing IBS from the other entities with specificity well above 90% and a positive predictive value of 98.6% allowing clinicians to rule out Crohn’s Disease or Ulcerative Colitis.

This is a step in the right direction but it remains to be seen when the test will be available locally through commercial labs and if it really will allow us to eliminate the many tests we now do to distinguish these problems from one another.

Peppermint Oil for Irritable Bowel Syndrome Symptoms

At Digestive Disease Week meetings researchers discussed the success of slow release peppermint oil (IBgard) in reducing symptoms of irritable bowel syndrome. The study was reviewed in the online journal of the University of Pennsylvania School of Medicine, MedPage Today.

According to Brooks Cash, MD, of the University of South Alabama in Mobile and associates, the number of severe and unbearable symptoms were significantly reduced using their delayed release peppermint oil tablet. Peppermint has been used for generations to reduce intestinal problems. I remember as a first year medical student, diagnosed with “ spastic colon” being prescribed peppermint flavored “ Tincture of Rhubarb and Soda” by the Chief of Gastroenterology at the SUNY Downstate Medical Center. Taken before meals, it produced a warm soothing feeling on the way down followed by a gentle burp. The tincture was mixed in traditional pharmacies which were all “compounding pharmacies” in those days. It is virtually unobtainable today. Peppermint oil is available over the counter today in the form of gel caps and tablets with an unpredictable delivery system. When the peppermint oil is released early in the stomach it can cause heartburn and dyspepsia. When it is released later it can produce rectal irritation and burning and lower gastrointestinal discomfort.

The new product, IBgard, has a delivery system that allows it to leave the stomach before its product is released in the small intestine where the environment is right for a positive effect. The product is produced by IM HealthScience in Boca Raton, Florida and is expected to be on the shelves in June. Patients are advised to take two tablets 30- 90 minutes before a meal, three times a day. A package of 48 tablets should sell for about $30.