An Ayurvedic Look at Irritable Bowel Syndrome.
By Carrie Demers, MD
Jennifer is an accomplished artist who is beginning to make a name for herself. She lives in the country on four acres of forested land and she spends her time painting, preparing for upcoming shows, marketing her prints, and taking care of her house and yard. She has a Siamese cat, but it is her cocker spaniel, Reilly, that is her constant companion. She is 56, single, and has many close friends. Even though her life is going well, Jennifer is anxious. She worries about money and the success of her next show. She frets about what would happen to her pets if anything were to happen to her. She is restless and sleeps lightly.
Jennifer’s time is unscheduled and her days often chaotic. She gets up whenever she feels like it, shops for groceries sporadically (often forgetting there is no food in the house), accidentally bounces checks, sometimes lets bills slide, and spontaneously takes the afternoon off and goes visiting whenever the mood strikes. Although she paints every day and tries to plan for her shows, she is often pushed at deadline time. When she is absorbed in her work, she will paint into the wee hours of the morning, forgetting both food and sleep (she would say these have never been important to her anyway). She doesn’t like to cook, so she eats mostly cold food that requires no preparation. A typical day’s diet is a bowl of cereal for breakfast with a cup of tea, rice cakes with peanut butter and an apple for lunch, fat-free strawberry yogurt for a snack, and grilled fish and a salad for supper.
Jennifer has never been especially athletic. She sometimes takes walks in the woods with her dog but has little motivation to do more. She rationalizes that her work is physical enough and that she goes folk dancing once a week. Her body is slender and agile, but she is beginning to notice that she feels stiff and achy after a long drive.
Her energy at the end of the day varies, especially when her digestive system is acting up, as it has been of late. She has gas, which causes pain, distention, and discomfort (and makes her pants too tight). Her stomach rumbles and grumbles and she feels heavy after eating—as if her food is just sitting in her stomach. Occasionally she has cramping and diarrhea, usually when she is under stress—transporting her paintings to a show, for example, or scurrying to meet a deadline—but more often she is constipated.
Jennifer has been diagnosed with irritable bowel syndrome (IBS). Her doctor also performed a series of diagnostic tests (blood tests, sigmoidoscopy, allergy testing), all of which were negative, although she did have a mild reaction to wheat and dairy products. Her doctor recommended a soluble fiber supplement (Metamusil) for the constipation and prescribed a variety of drugs to help manage her symptoms: an anti-gas medication, a laxative, an anti-diarrhea medication, and a drug that encourages gastric motility. Her doctor has told her that her condition is incurable, an opinion reinforced by the specialist she consulted for a second opinion.
Irritable bowel syndrome is the most common gastrointestinal disease in clinical practice. Approximately 35 million people in the U.S. are affected by IBS, usually young-to-middle-aged adults, and twice as many women as men. Jennifer’s symptoms are typical: constipation alternating with diarrhea, bloating, gas, and general indigestion. Some people have predominantly abdominal pain and constipation, others have diarrhea more frequently. Although it is not a serious health problem in the sense that it doesn’t progress to a more serious condition like colitis or cancer, IBS is uncomfortable and unnerving.
The Western medical approach to this disorder is to rule out a more serious problem with a battery of tests, and then treat the condition symptomatically, as was done in Jennifer’s case. Cure is not expected because the cause of irritable bowel syndrome is unknown, although it is clear that stress plays a role. Like Jennifer, patients are usually advised to learn to live with it.
The ayurvedic approach is infinitely more hopeful. All illnesses are considered imbalances of the doshas (the three humors of the body), and most are curable with balancing therapies. Jennifer’s variable intestinal symptoms are signs of an imbalance of vata (the dosha associated with air). Vata resides primarily in the colon, and when out of balance it creates erratic symptoms (especially gas and constipation). Like the wind, vatic conditions tend to have the qualities of dryness, coldness, and irregularity. These can manifest as coldness of the body, dryness of skin, eyes, and/or mouth, or dryness in the intestinal tract, which causes constipation (lack of lubrication leads to dry hard stool that doesn’t pass readily). A vata imbalance also manifests as irregularity of symptoms, for example, variable digestive complaints, unpredictable menses, or fluctuating blood sugar.
Those who have a predominance of vata dosha are prone to these imbalances. They tend to have irregular digestion patterns, and irregular energy levels (it comes in “gusts”). Mentally and emotionally, vatic types tend to be creative and intuitive; they are attuned to the beauty in any situation, but are also sensitive to the ugliness (loud noises, bright lights, strong odors, injustice). Their sensitivity often makes them feel that they need more insulation between themselves and the world. They love travel, and are stimulated by change, but this aggravates their already restless minds. They tend to learn quickly and forget just as quickly. Their nature puts them on a roller coaster ride that is exhausting and makes them more prone to feeling unstable and anxious. The goal of ayurvedic therapy is to rebalance vata and thus minimize irregularity and coldness, and maximize routine, warmth, and moisture by way of food, drink, herbs, massage, and exercise.
Jennifer’s journey to self-understanding began when she was introduced to hatha yoga by a friend who didn’t want to go to class alone. They took an eight-week class. Jennifer enjoyed the emphasis on relaxation. She noticed that her bowel symptoms often improved after class and that she slept better those nights. She mentioned this to her instructor, who encouraged her to enroll in a weeklong ayurvedic rejuvenation program at a yoga retreat center to work on healing her intestinal disturbance.
Because wind is changeable and chaotic, routine and consistency are essential in balancing vata. So during her rejuvenation program Jennifer follows a strict schedule of waking and sleep, exercise and rest, meals, snacks, and relaxation sessions. She wakes at 6:00 a.m. and cleanses her body by taking a shower, doing the nasal wash, and drinking a cup of hot water with lemon and honey to facilitate a bowel movement. At 6:45 she goes to a gentle yoga class ending with a guided relaxation. Breakfast is served at 8:00 a.m. Afterward she has a biofeedback session, a yoga therapy session, and a massage. She has a juice break between morning sessions and takes a brisk walk before lunch at 12:30. In the afternoon she attends a cooking class, reads, and practices sandbag breathing. Supper is served at 6:00 p.m., and in the evening Jennifer attends lectures on nutrition, ayurvedic philosophy, and stress reduction. Before bed she practices a systematic relaxation and turns in by 10:00 p.m.
Vatic people tend to get scattered, disorganized, confused, and anxious easily, and this generates considerable stress. They benefit from slowing down and collecting themselves. In Jennifer’s ayurvedic rejuvenation program diaphragmatic breathing is the foundation of stress reduction because it activates the parasympathetic nervous system, calming the body and nervous system and making it easier to focus the mind. Relaxation exercises based on diaphragmatic breathing transform a whirlwind into a calm breeze.
Jennifer is first taught to relax lying on her back in the corpse pose. Once she is breathing effortlessly in that position, she is introduced to sandbag breathing—a specially designed 8-pound to 10-pound sandbag is placed over her abdomen below the rib cage to strengthen the diaphragm muscle, and this in turn helps her breathe deeply, slowly, and evenly.
She also learns a systematic relaxation that guides her through her whole body from head to toes, consciously relaxing each part. Jennifer finds this restorative. She is given a tape to use when she returns home and is reminded to practice diaphragmatic breathing anytime she feels anxious or scattered. She is also advised to breathe diaphragmatically for a few minutes just prior to meals to ensure that she is relaxed and receptive to nourishment.
Massage Oil massages are essential to keep vatic types in balance, especially during the cold, dry months of winter. Warm oil is nourishing to vatic skin, countering dryness while increasing circulation. It is also deeply relaxing. Jennifer finds the daily massages calming and always walks away smiling.
Because of their weak digestion, vatic people benefit from building strength in their solar plexus, and in hatha, the best exercise for this is agni sara. In this practice the base of the body is “locked” by contracting the pelvic floor muscles; and after exhaling upward from the pubic bone to the chest, the chin is also “locked” by bringing it to the sternum. These locks are a way of holding in prana, or energy; agni sara helps create, preserve, and compress energy. Even a brief daily practice strengthens digestive power and builds heat. A more intense practice engenders energy and clarity of mind.
Vatic types are prone to weak, unstable joints, and so need to focus on strengthening poses. Standing poses (lunge, warrior series, triangle, angle, etc.) and balancing poses (tree, king dancer) that help vatas ground down through the feet are especially helpful. Vatic types also need aerobic exercise because it is warming and builds digestive strength. Low-impact forms of exercise, such as swimming, walking, bicycling, dancing, skating, and rollerblading are best.
Jennifer is encouraged to continue folk dancing and to walk more often. During her daily yoga therapy sessions, the therapist works with her on the standing and balancing poses, as well as on poses for preserving flexibility. The therapist emphasizes the importance of moving with awareness of the breath. Jennifer finds this difficult at first, but by midweek she is able to stay focused on her breathing, and has the pleasant sense of really being in her body, rather than just in her head.
Vata is balanced by food that is cooked, warm, moist, moderately spiced, nourishing, and a bit oily. Sweet and salty tastes are especially important. Sweet foods (grains and dairy products, fruits, and natural sweeteners) are nourishing. Salt holds water, countering the tendency to dryness; it also stokes the digestive fire. Because vatic people tend toward weak digestion, herbs that increase digestive fire are useful: ginger, garlic, cumin, turmeric, coriander, cinnamon, clove, bay leaf, and fenugreek. Once digestion is sufficiently strengthened, dairy products can be introduced. Gassy vegetables, such as broccoli, cabbage, cauliflower, and most beans are best avoided for obvious reasons. Cold, light, and dry food further imbalance vata: salad and other raw food, puffed grains, carbonated drinks, light crunchy snacks, and even yeast bread (it’s full of air) are best eaten in small quantities.
These principles are explained to Jennifer. During her stay her meals consist of whole grains (rice, oats, spelt, whole wheat), watery and root vegetables (squash, pumpkin, yam, carrot), sweet fruits (oranges, pears, cooked apples), nuts, tofu, and dairy products. Salads, vegetables from the cabbage family, and most beans are not included. At midmorning she drinks a mixture of carrot and apple juice (sweet, nourishing, and cleansing) and every afternoon she is given hot spiced milk with a sweet snack. Despite her mild allergy to dairy products, she finds that cheese, made fresh at the retreat center, and the spiced milk cause no gastric problems.
Jennifer is also coached to be aware of what and how she eats and to taste, chew, and swallow it with awareness. She attends cooking classes to learn to make these dishes herself. She appreciates the subtle flavors of foods she is being introduced to and is excited about expanding her menu at home.
Generally vatic types need to take herbs that are building, strengthening, and nourishing. A few of the most powerful ayurvedic herbal tonics are ashwagandha, shitavari, and punarnava. All of these herbs have a sweet taste and build immune strength, virility, and energy.
For the intestinal tract, soluble fiber (psyllium-seed husk) is essential, at least until the bowels are in good working order again. Soluble fiber can act either as a laxative or as an anti-diarrheal agent: it absorbs water which helps counter diarrhea, while its mucinous quality and bulk have a laxative effect. Triphala is also a good tonic for strengthening bowel function. Insoluble fiber, such as bran, is dry and acts as a laxative by irritating the bowel wall, and so it should be avoided by anyone tending toward a vata imbalance.
Jennifer takes psyllium-seed husk mixed in a large glass of water or juice every morning, and a cup of triphala tea before bed. She takes a mixture of the strengthening herbs mentioned above in pill form twice a day, along with skullcap, licorice, and schizandra.
When she goes home Jennifer will continue this regimen for at least two months. As her bowel normalizes she will stop taking the psyllium seed, and over a period of three to six months she will gradually stop drinking the triphala tea and taking the other herbs, using them only if symptoms recur.
Jennifer has been coached on how to create a schedule to give her days some structure when she gets home. She is advised to wake, eat, sleep, exercise/stretch, and relax at regular times. Although she knows it will be challenging to curb her free-wheeling ways, she is so encouraged by the marked improvement in her symptoms that she is determined to change her habits.
She leaves the retreat center with some trepidation: will she really be able to implement what she learned? The staff assures her that any changes she makes consistently, no matter how small, will have a positive effect, and that this in turn will motivate her to make other changes. They will be available by phone if she has questions or concerns, and she is encouraged to follow up in six to eight weeks for both assessment and encouragement.
Board-certified in internal medicine, Carrie Demers, MD, is the director of the Himalayan Institute Total Health Center.