Dear Reader, If your boyfriend is a gangster and you're giving the FBI information about him behind his back, chances are your stress level might contribute to poor digestion. Or worse.

Fans of the Sopranos TV show will recognize the situation described above. Adrianna was the character's name, and like 20 percent of the population she suffered from irritable bowel syndrome (IBS), with symptoms such as chronic diarrhea, constipation, gas and bloating.

Alas, IBS is no longer a concern for Adrianna (let's just say her health problem was solved the "Tony Soprano" way). But for those who still cope with IBS, a new study from China shows that two of the painful symptoms associated with the condition might be relieved with a daily supplement.

Gut check

Melatonin is a hormone that helps regulate the body's sleep/wake circadian rhythm that ideally remains consistent from night to night. In addition, melatonin also plays a role in the normal functioning of the gastrointestinal tract. Researchers in the Department of Medicine at the National University of Singapore conducted a study to determine if a melatonin supplement might improve bowel problems as well as sleep disturbances in patients with IBS.

The Singapore team recruited 40 IBS patients between the ages of 20 and 64 who also had trouble sleeping. Half of the subjects were randomly assigned to receive 3 mg of melatonin nocte (which is Latin for "every night"). The other group of subjects received a placebo. Each of the subjects completed questionnaires about bowel conditions and sleep patterns before and after the two-week testing period. In addition, nightly sleep activity was monitored throughout the fortnight.

Results revealed two positive outcomes: Subjects in the melatonin group experienced a significant reduction in abdominal pain compared to the placebo group. The melatonin subjects also showed improvement in their rectal pain threshold.

No significant difference was reported from either group in bloating, stool type or stool frequency. Psychological questions on the pre- and post-test questionnaires also revealed no important changes in anxiety or depression.

Pumping too much gas

There's a good reason why the subjects in the Singapore study received their supplements nocte: Melatonin has been shown to be an effective sleep aid. Oddly, however, subjects in the melatonin group of the Singapore test reported little change in sleep duration or efficiency. But melatonin didn't relieve bloating, which could easily account for interrupted sleep. Perhaps melatonin just needs some additional help in order to be more effective.

In the e-Alert "Gut Feeling" (10/27/04), I told you about research that shows how bloating may be the key to one of the primary causes of IBS.

Henry C. Lin, M.D., is a gastrointestinal specialist and an associate professor of medicine at the University of Southern California. Over the years, Dr. Lin noticed that almost all of his IBS patients experienced post-meal bloating. This prompted him to focus his research on gas caused by gut bacteria that ferments food in the intestinal tract. Some bacteria perform useful functions in the large intestine, but Dr. Lin suspected the bacteria might be migrating to the small intestine, triggering gas and bloating.

After a breath-test study indicated that a large majority of IBS patients have small intestinal bacterial overgrowth (SIBO), an antibiotic trial helped confirm the results. In that trial, IBS patients received either an antibiotic or placebo. About 75 percent of the subjects who successfully eliminated SIBO with antibiotics reported a significant improvement in IBS symptoms.

Melatonin + antibiotics + probiotics

The use of antibiotics in Dr. Lin's study may have been helpful in demonstrating how bacteria play an important role in prompting IBS symptoms, but whenever antibiotics are used, probiotics need to be considered.

In several e-Alerts, HSI Panelist Allan Spreen, M.D., has written about the necessity of probiotic organisms, which can be destroyed by antibiotics. In a healthy individual, these beneficial bacteria inhabit the digestive tract in massive numbers, crowding out harmful bacteria and supporting proper digestion. When the activity level of good bacteria drops too low, it opens the door for harmful bacteria to proliferate, allowing the opportunity for diseases such as IBS to develop.

Dr. Spreen: "I absolutely would be giving probiotics for such a problem, along with any agents that might assist strengthening the intestinal wall, such as FOS (fructo-oligo-saccharides), which helps the 'good' bugs to reestablish, aloe juice, which has a long history of calming bowel problems, essential fatty acids, and digestive enzymes (which are usually underproduced in such situations)."

For most people, sufficient amounts of intestinal flora can be maintained through dietary sources such as cultured products (yogurt and kefir), and lignans (flaxseed, carrots, spinach, cauliflower, broccoli, millet and buckwheat). But while the digestive tract can be "re-colonized" by introducing enough good bacteria to overpower the bad bacteria, dietary sources alone can't provide organisms in the vast numbers required to correct a serious imbalance. For this, a high-potency probiotic nutritional supplement may be necessary.

One word of caution: Bacterial imbalances in the intestine should not be taken lightly. So talk to your doctor or a health care professional before using a probiotic supplement or melatonin to address IBS.

To Your Good Health, Jenny Thompson, Health Sciences Institute

Sources:

"Melatonin Improves Abdominal Pain in Irritable Bowel Syndrome Patients who have Sleep Disturbances: A Randomized Double Blind Placebo Controlled Study" Gut Online, 5/24/05, gut.bmjjournals.com
"Melatonin Eases IBS Pain" Natural Products Insider, 5/31/05, naturalproductsinsider.com
"Small Intestinal Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome" Journal of the American Medical Association, Vol. 292, No. 7, 8/18/04, jama.ama-assn.org "Merck Considered Reformulating Vioxx 5 Years Ago" Associated Press, 6/23/05, thewbalchannel.com