You only have to read a few posts of the WB before you find out that I am a former IBS sufferer. In fact, I would say IBS is one of the top three reasons I turned to alternative and nutritional medicine. No conventional physician was able to help me solve my IBS, which for me appeared as daily diarrhea, bloating, and gas.
Now, doctors are starting to push antibiotics for a condition that may often be solved by lifestyle and diet adjustments, as well as less invasive alternative treatments?? Give me a break! Here is a perspective on this new development from WB community member and licensed acupuncturist, Sara Calabro.
By Sara Calabro, LAc
Founding editor of AcuTake
Doctors are like kids in candy stores when it comes to antibiotics. They just can’t help themselves. Despite overwhelming evidence of antibiotics resistance and the fact that in the majority of cases the risk of taking antibiotics far outweighs the benefit, prescriptions are still flying off their pads. Now, with the release of new research on irritable bowel syndrome (IBS), doctors are faced with the temptation to put even more people on antibiotics. It’s as if the candy store just doubled in size.
The research, published in a January issue of The New England Journal of Medicine, shows that a two-week course of antibiotics helped IBS symptoms in 41 percent of patients. Although the findings are neither impressive (30 percent got better with placebo), comprehensive (patients with constipation were not included), nor unbiased (the studies were sponsored by Salix Pharmaceuticals, the drug’s maker), they provide doctors, finally, with something to offer their IBS patients.
IBS has proven especially tough for mainstream medicine to gets its arms around. Stress is known to play a significant role, leading many doctors to prescribe anxiety or depression drugs, but a clear physiological explanation remains elusive within biomedical parameters. Acupuncture, because it considers the interdependent relationships of anatomical structures and how they’re affected by emotional and environmental factors, is a more sensible approach than medication for IBS.
Given the complicated nature of IBS, it’s not surprising that medications, which work by targeting isolated structures within the body, have so far been a bust. Zelnorm, a popular IBS drug for people who tended toward constipation, was pulled from the market in 2007 because it was shown to increase risk of stroke and heart attack. Lotronex, given to people whose IBS mostly involves diarrhea, is known to cause serious side effects such as colitis and severe constipation.
The fact that these medications—as well as rifaximin, the antibiotic used in the NEJM studies—treat constipation or diarrhea is problematic. Many people with IBS suffer from both constipation and diarrhea, an alternating of the two. It’s an issue of regulation, or lack thereof. Even in people who tend toward one or the other, completely shutting down or revving up the bowel is not going to solve the larger imbalance that’s causing symptoms in the first place.
Acupuncture works differently than medications in that its effects are dictated by the person receiving the treatment. For example, ST25, a common acupuncture point for digestive disorders, is used for both constipation and diarrhea. In a person with constipation, ST25 activates the bowel, while in someone with diarrhea, it slows things down. Medications force the body toward a particular outcome, usually by either adding or taking something away—the NEJM study, for example, was based on the idea is that IBS symptoms are caused by an overgrowth of bacteria in the small intestine; by killing that bacteria, you kill the symptoms. In contrast, acupuncture gets the body’s existing components working more smoothly.
One way it does this is by calming the sympathetic nervous system. Stress, in biomedical and acupuncture circles alike, is an established component of IBS. According to Hans Selye’s General Adaptation theory, our bodies react to long-term stress by developing patterns, or diseases, of adaptation. These can be anything from IBS to insomnia to back pain. Acupuncture helps modulate our natural stress response, thereby decreasing the “need” to develop adaptation patterns/diseases.
But even once a pattern has developed, acupuncture is still a better bet than meds. Chronic stress—emotional as well as physical stress, such as too many sit-up exercises—can lead to trigger points in the abdominal muscles. While trigger points are traditionally thought of in relation to pain, they also can cause visceral symptoms such as constipation, diarrhea and others that are characteristic of IBS. When indicated, trigger-point acupuncture can resolve many of these problems.
According to NPR, rifaximin has limited side effects because it stays in the gut and doesn’t enter the bloodstream the way other antibiotics do. But PubMed lists the following as potential side effects: hives; skin rashes; itching; difficulty breathing or swallowing; swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs; hoarseness; fever, chills, sore throat, and other signs of infection. And this list does not even touch upon the potential long-term repercussions of killing off all bacteria, good and bad, in a part of the body whose function is dependent on a healthy bacterial balance.
Even more troubling than the risk of side effects may be mainstream medicine’s tendency to overuse antibiotics. Since rifaximin is already approved for travelers’ diarrhea, it’s available now for doctors to prescribe off-label for IBS. But the two-week course of treatment is pricey, about $900. These recent studies allow Salix to apply for FDA approval for the IBS indication. If that comes through, insurance companies are more likely to cover it and doctors are more likely to prescribe it.
Mainstream medicine’s reliance on antibiotics is already a problem of epic proportions, thanks to years and years of inappropriately treated ear infections and sore throats. If your doctor suggests antibiotics for IBS, think twice—question the recommendation and do your homework. There are other options worth trying first. Acupuncture is a safe and comprehensive way to effectively address this multifaceted condition.
Sara Calabro, LAc, is a former healthcare business journalist and the founding editor of AcuTake, a website dedicated to improving acupuncture education and access.