IBS Remedies

Probiotics: "friendly" bacteria supplementation

Probiotics are "good" bacteria that normally live in the intestines and are found in certain foods (e.g yogurt). Probiotics consist of a preparation containing a single- or mixed-culture of live microbes that help to normalize the gastrointestinal flora. They may suppress the inflammation associated with IBS or restore normal local immune function. Studies with probiotics demonstrate a trend toward improvement of IBS and are promising enough. However, not all studies have had positive results.

The great advantage of probiotics is their safety. When tested in clinical trials, they have done no harm.

Lactobacilli and Bifidobacteria subspecies are able to deconjugate and absorb bile acids, potentially reducing the colonic mucosal secretion of mucin and fluids that may contribute to functional diarrhea or IBS with diarrhea. Therapeutic trials show the potential benefit of Bifidobacteria or Lactobacilli species alone or in the specific probiotic combination on IBS.

One research study has shown a clear link between the ingestion of Lactobacillus plantarum LP299V and sufferers of IBS who reported resolution of their abdominal pain. Another study showed the utility of B. infantis 35625, a strain of Bifidobacteria in normalizing bowel movement frequency in sufferers of IBS. Some practitioners of Integrative Medicine now recommend a strain of Lactobacillus known commonly as "LGG" after its discoverers Gorbach and Goldin. This strain in particular has shown an ability to endure the acidic environment of the stomach and survive until presentation to the intestinal tract. A prospective placebo-controlled study found patients with diarrhea predominant IBS taking Saccharomyces boulardii, a probiotic yeast, had a significant reduction on the number and improvement in consistency of bowel movements.

• 1. Choi SC, Kim BJ, Rhee PL, Chang DK, Son HJ, Kim JJ, Rhee JC, Kim SI, Han YS, Sim KH, Park SN. Probiotic Fermented Milk Containing Dietary Fiber Has Additive Effects in IBS with Constipation Compared to Plain Probiotic Fermented Milk. Gut Liver. 2011 Mar;5(1):22-8. PubMed
• 2. Drouault-Holowacz S, Bieuvelet S, Burckel A, Cazaubiel M, Dray X, Marteau P. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol. 2008 Feb;32(2):147-52
• 3. Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010 Mar;59(3):325-32.
• 4. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O'Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006 Jul;101(7):1581-90

Fiber

In many cases, dietary fiber may lessen IBS manifestations, particularly constipation. However, it may not help pain or diarrhea. The proposed mechanism of action is the enhancement of the stool's water-holding properties, gel formation to provide lubrication, bulking of the stool, and binding of agents such as bile. A systematic review of 13 randomized controlled trials found no convincing evidence that bulking agents relieve global signs of IBS. However, a second systematic review did find significant improvement in the ease of stool passage and in general satisfaction with bowel movements.

There are two types of fiber: soluble and insoluble. Insoluble fiber is "rough". It does not dissolve in water, so it passes intact through the intestinal tract, increasing the frequency, water content, and looseness of bowel movements. In comparison, soluble fiber is "smooth," and is soothing to the digestive tract. It absorbs excess water in the colon, pushes through impacted fecal matter, and regulates intestinal contractions. In this way it helps to prevent the painful spasms, and relieves both the diarrhea and constipation of IBS.

Naturally high in soluble fiber are oatmeal, pasta, rice, potatoes, soy, barley, nuts, beans, and oat bran. Though insoluble fiber is very beneficial for overall health, it must be introduced carefully, as it can also trigger severe attacks of pain and diarrhea in IBS sufferers. Whole-grain breads and cereals, wheat bran, and fruits and vegetables are all great sources of insoluble fiber. Be sure to increase fiber intake slowly to avoid gas and bloating.

Because of its safety, a trial of fiber is reasonable, particularly in people who suffer from constipation.

• 1. Parisi GC, Zilli M, Miani MP, et al. High-fiber supplementation in patients with irritable bowel syndrome (IBS): a multicenter, randomized, open trial comparison between wheat bran and partially hydrolyzed guar gum (PHGG). Dig Dis Sci. 2002 Aug;47(8):1697-704. PubMed
• 2. Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009 Aug 27;339:b3154

Peppermint

Peppermint can improve gut motility and digestive function. Peppermint leaves contain oils that have mild anesthetic and antispasmodic properties, relieve nausea, and relax smooth muscle spasticity. Peppermint oil can reduce abdominal pain and distension of IBS, possibly by blocking the influx of calcium into muscle cells and inhibiting excess contraction of intestinal smooth muscles.

Several studies have shown that peppermint can help in IBS, particularly when cramping and diarrhea are major problems. Peppermint oil can be taken in either capsules or tea. Enteric-coated capsules keep the oil from being released in the stomach, which can lead to heartburn and indigestion. Peppermint oil has even been approved for use by IBS patients in Germany.

A randomized double-blind placebo-controlled study of enteric-coated peppermint oil involving 110 patients showed 79% with less pain, 83% with decreased stool frequency, and 79% with less flatulence.

Peppermint combined with caraway oil, calms stomach muscles and improves the flow of bile, which digests fats.

Do not use Peppermint if you have chronic heartburn, severe liver damage, inflammation of the gallbladder, obstruction of bile ducts, or if you are pregnant.

• 1. Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001 Jan;138(1):125-8
• 2. Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007 Jun;39(6):530-6
• 3. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The action of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010 May;55(5):1385-90

Artichoke

Artichoke leaf extract helps and improves quality of life in persons with IBS. It stimulates the liver to produce bile secretion which increases digestive activity. Artichoke leaf extract can relieve flatulence, nausea, bloating, abdominal pain.

Do not take artichokes if you have a bile duct blockage.

• 1. Bundy R, Walker AF, Middleton RW, Marakis G, Booth JC. Artichoke leaf extract reduces signs of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. J Altern Complement Med. 2004 Aug;10(4):667-9.
• 2. Walker AF, Middleton RW, Petrowicz O. Artichoke leaf extract reduces expressions of irritable bowel syndrome in a post-marketing surveillance study. Phytother Res. 2001 Feb;15(1):58-61.

Melatonin

Melatonin is a promising remedy for IBS. This hormone is involved in the regulation of gastrointestinal motility and sensation.

Three small studies suggest that use of the melatonin supplement may reduce pain and rectal urgency associated with IBS. It has been suggested that the hormone melatonin may have an an influence on the nervous system in the digestive tract.

• 1. Saha L, Malhotra S, Rana S, Bhasin D, Pandhi P. A preliminary study of melatonin in irritable bowel syndrome. J Clin Gastroenterol. 2007 Jan;41(1):29-32.
• 2. Song GH, Leng PH, Gwee KA, Moochhala SM, Ho KY. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut. 2005 Oct;54(10):1402-7
• 3. Lu WZ, Gwee KA, Moochhalla S, Ho KY. Melatonin in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2005 Nov 15;22(10):927-34.

Padma Lax

Padma Lax, a herbal laxative on the basis of Tibetan formulas, is a safe and effective treatment for constipation-predominant irritable bowel syndrome and may offer an alternative to the current multi drug approach.

• 1. Gschossmann JM, Krayer M, Flogerzi B, Balsiger BM. Tibetan herbal formula Padma(R) Lax on visceral nociception and contractility of longitudinal smooth muscle in a rat model. Neurogastroenterol Motil. 2010 Jun 1
• 2. Sallon S, Ben-Arye E, Davidson R, Shapiro H, Ginsberg G, Ligumsky M. A novel treatment for constipation-predominant irritable bowel syndrome using Padma Lax, a Tibetan herbal formula. Digestion. 2002;65(3):161-71

Aloe Vera

Aloe vera is a popular remedy for digestive problems. Aloe vera juice is a complex mixture of more than 75 biologically active chemicals. It is often used for topical treatment of wounds and skin irritations, for constipation, ulcers, and to control abdominal discomfort.

According to the research, Aloe vera may help those with diarrhea predominant or alternating diarrhea and constipated IBS.

• 1. Davis K, Philpott S, Kumar D, Mendall M. Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. Int J Clin Pract. 2006 Sep

Ginger

The herb ginger also may play a role in IBS treatment. It has a mild inflammatory and antispasmodic action. Also, ginger contains powerful digestive enzymes. One component, gingerois, functions as a serotonin 5-HT antagonist and enhances motility. Ginger helps prevent vomiting, and improves intestinal muscle tone.

Do not take ginger if you have a bile duct obstruction or gallstones. Ginger may stimulate bile production. High doses of ginger (6 grams or more) can cause damage to the stomach lining and ulcers. Ginger can cause allergic skin reactions. Consult your doctor before taking ginger if you take blood thinners such as warfarin (Coumadin). Ginger can increase the risk of bleeding.

Chamomile

Chamomile is known to soothe the digestive tract as an antispasmodic and anti-inflammatory agent. Chamomile is sometimes used to relieve alternating bouts of diarrhea and constipation. It is also helpful for indigestion, flatulence, and intestinal cramps.

Chamomile can be taken as a tea, or as a capsule. The easiest and most effective dose is to drink a cup of chamomile tea after meals.

Chamomile is considered very safe.

Digestive enzymes

Digestive enzymes are substances designed to break down meal for digestion, they can enhance nutrient absorption. A number of different digestive enzymes are found in raw fruits and vegetables. Some pancreatic enzymes are involved in the development of IBS.

Digestive enzymes can be helpful when taken right before a meal, especially if there is more fat in that meal than it is safe for IBS. Enzymes may be of more benefit to older people, as natural digestive enzyme production declines with age.

Evening Primrose Oil (Oenothera biennis)

Evening primrose oil is a rich source of omega-6 essential fatty acid called gamma-linolenic acid (GLA).

Many women experience the worsening of IBS during their menstrual period. Evening primrose oil may help in women who experience a worsening of pain, discomfort, and bloating during their menstrual period.

Turmeric (Curcuma longa)

Turmeric contains an active ingredient called curcumin, that is used for cooking and as a medicine. Researchers found that standardised turmeric extracts can provide significant relief from abdominal pain and flatulence.

Also, turmeric can reduce inflammation in the lining of the bowel and improve overall bowel function.

• 1. Bundy R, Walker AF, Middleton RW, Booth J. Turmeric extract may improve irritable bowel syndrome in otherwise healthy adults: a pilot study. J Altern Complement Med. 2004 Dec;10(6):1015-8.

Acupuncture

Acupuncture is a popular alternative therapy that may help some people with IBS.

Researchers at the National Institutes of Health (NIH) have found that acupuncture can provide relief from chronic pain. Although study results have been mixed, some IBS sufferers use acupuncture to help relax muscle spasms and improve bowel function.

In addition, acupuncture is an effective treatment for problems that often trigger IBS, such as stress, anxiety, insomnia, menstrual cramps.

• 1. Lembo AJ, Conboy L, Kelley JM, et al. A treatment trial of acupuncture in IBS patients. Am J Gastroenterol. 2009 Jun;104(6):1489-97.
• 2. Anastasi JK, McMahon DJ, Kim GH. Management of irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion. Gastroenterol Nurs. 2009 Jul-Aug;32(4):243-55.
• 3. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111.

Hypnotherapy

Hypnotherapy, the therapy that only affects the mind, has been proven to be highly effective treatment for alleviating pain, diarrhea, constipation, bloating, and nausea due to irritable bowel syndrome. Perhaps the benefits of hypnotherapy lie with the relaxation and de-stressing that occurs for patients receiving the therapy.

Researchers found that gut-directed hypnotherapy results in significant, long-term improvements in irritable bowel syndrome.

• 1. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol. 2002 Apr;97(4):954-61.
• 2. Roberts L, Wilson S, Singh S, Roalfe A, Greenfield S. Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial. Br J Gen Pract. 2006 Feb;56(523):115-21.