New hope for IBS sufferers

A recent clinical trial has given further weight to the acceptance that supplemented dietary nucleotides, essential building blocks, can support the rapid production of new cells, which is beneficial for adult immunity and gut health.

This 2005 clinical trial, the effectiveness of a nucleotide supplement in the management of individuals with Irritable Bowel Syndrome (IBS), was sponsored by a grant from the Dept Trade and Industry, and conducted at the University of East London, under control of Professor Christine Dancey. Professor Dancey heads the Dept of Psychology and the Chronic Illness Research Team (CIRT) and is the co-founder of IBS Network.

IBS is one of the most prevalent chronic illnesses, and present’s itself through a number of symptoms. The most severe cases generally include the following symptoms. Abdominal pain, varying from mild to extremely severe; this is the symptom which causes most sufferers to seek medical help. Diarrhoea, constipation – or worse, an alternation of both are common. Urgency to have a bowel movement – also affects people with constipation as well as diarrhoea, and a feeling of incomplete evacuation.

Current medical treatments are directed at symptomatic relief, and although these – and psychological treatments – can help relieve IBS, there is no one treatment which has been shown to be lastingly effective. Although IBS is not a life-threatening disease, the symptoms and the effects of the symptoms on daily life can have a great impact on sufferers (Silk, 2001). IBS is also associated with large healthcare and economic costs in terms of hospital investigations, repeated visits to GPs, prescription medicines, and loss of time from work (Creed et al 2001).

Since there is no cure for IBS, people with IBS attempt to control their disorder by taking both prescribed medicines and over-the-counter remedies, together with dietary control. Some are living on extremely restricted, and therefore unhealthy, dietary regimes. In an earlier study of people with IBS, Dancey & Backhouse (1993) found that 14% of their sample (N=148) ate very restricted diets hoping that this would cure their IBS. However most of their sample (70%) said that they were trying to follow a healthy diet with plenty of fruit and vegetables.

This clinical trial was carried out to determine whether a nucleotide supplement, could improve the symptoms of IBS. Nucleotides are substances which are synthesised endogenously, and have important effects on the growth and development of cells which have a rapid turnover, such as those in the immune system and the gastrointestinal tract. In healthy people, dietary nucleotides are probably not essential, and in fact most will be metabolised and rapidly excreted from the system. However, under certain circumstances e.g. in the sub-well, diseased, or under conditions of stress or poor diet, dietary nucleotides may be what Maldonado et al (2001) call “semi-essential”, optimising the function of the gastrointestinal and immune systems. In relation to the gastrointestinal system work has shown that dietary nucleotides enhance the intestinal absorption of iron (Cosgrove 1998).

Holen & Jonsson (2004) found that dietary nucleotides had beneficial effects, especially when the nutrition supply was inadequate. Work with infants has shown that the incidence and duration of acute diarrhoea is lower in infants when dietary nucleotides are included in their diets (Gil, 2002). Research has shown the benefits of dietary nucleotides in a variety of ways, and it would be expected that people with Irritable Bowel Syndrome may benefit from nucleotide supplementation.

The chronic illness research team from the University of East London (Professor Dancey & colleagues) carried out a double blind randomised placebo controlled study to determine whether there were any benefits of nucleotide supplement on some of the common symptoms of IBS. Symptoms which bother participants the most are pain, diarrhoea, and urgency to have a bowel movement.

Seven symptoms of IBS were analysed by the participants, who rated symptoms every day on a scale of 1 (“no discomfort at all today”) to 7 (“very severe discomfort today”). All participants completed daily diaries throughout the trial. After an initial 4 weeks baseline, they were allotted to condition A or condition B. The capsules were taken three times a day with meals.

Psychological measures were taken at the beginning of the baseline period, the end of the experimental condition and the end of the placebo condition. Depression was measured by the CES-D, suitable for non clinical sample, and Anxiety measured by State-Trait. These are commonly used anxiety scales.

The drop-out rate for the trial was low. Participants dropped out for reasons other than adverse reactions to the intervention; in fact the placebo group had a higher drop out rate than the intervention groups.

Although there was a lot of variability with the daily scoring, it was clearly observed that symptoms were lower for all symptoms in the nucleotide supplement compared with the placebo.

During the baseline period subjects symptom severity went up and down, but clearly during both the placebo and with nucleotide supplement severity of symptoms improved. This improvement was more pronounced in the nucleotide supplement group and also the improvement continued and grew over time. In other words, the longer they took the nucleotide supplement the better they felt overall.

The strongest and most significant effects were observed for abdominal pain, urgency, incomplete evacuation and diarrhoea.

Repeated measures analyses of variance were carried out for each symptom separately; this involved finding the mean of baseline measures, placebo and nucleotide supplement conditions. Compared to both baseline and placebo conditions, the above symptoms are improved under the experimental condition (p

It might be expected that due to the benefits of being in a clinical trial, anxiety and depression would decrease over time. This was tested by a repeated measures analysis, comparing washout measures and end of trial measures without considering condition (placebo or experimental). There were no differences. There were also no significant differences in anxiety and depression between the 3 conditions.

The researchers concluded that the physical improvements observed were not due to psychological benefits of being in a clinical trial.

Overall 23.73% of the participants improved by taking the nucleotide supplement. Also, the benefits of the nucleotide supplement are greater than taking a placebo, the placebo effect usually being very high in IBS trials.

Also, it was clear that the nucleotide supplement helps certain symptoms more than others – abdominal pain, urgency to have a bowel movement, incomplete feeling of evacuation and diarrhoea. May be that a longer trial would have shown larger effects, especially as the placebo response diminishes over time.

However, there was a definite effect of IntestAid IB, which is due to direct effects on the maintenance and repair processes of the gastrointestinal system or by improvement in the gut immune function.

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