Natural Treatments for Irritable Bowel Syndrome (IBS)

Probiotics - Bacterial 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 exert beneficial health effects by altering (normalizing) the gastrointestinal flora. They may suppress the low-grade inflammation associated with IBS or restore normal local immune function. Studies with probiotics demonstrate a trend toward improvement of IBS symptoms and are promising enough to warrant further investigation. However, not all studies on probiotics have had positive results.

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 symptoms in 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.

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

Scientific evidence of Probiotic effectiveness

• A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. PubMed
• A probiotic treatment containing Lactobacillus, Bifidobacterium and Enterococcus improves IBS symptoms in an open label trial. PubMed
• Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study. PubMed
• Probiotics in the treatment of irritable bowel syndrome. PubMed
• Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. PubMed
• Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. PubMed
• The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial. PubMed
• A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. PubMed
• Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. PubMed
• Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. PubMed
• Clinical studies on alleviating the symptoms of irritable bowel syndrome. PubMed

High fiber diet or Fiber supplementation

In many cases, dietary fiber may lessen IBS symptoms, 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 (RCTs) found no convincing evidence that bulking agents relieve global symptoms 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. Foods that are naturally high in soluble fiber include oatmeal, pasta, rice, potatoes, soy, barley, nuts, beans, and oat bran. Though insoluble fiber is very beneficial to your overall good 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. If you don't usually eat a lot of fiber, be sure to increase your intake slowly to avoid gas and bloating.

Because of its safety and low cost, a trial of fiber is reasonable, particularly in patients whose predominant symptom is constipation.

Peppermint

Peppermint possesses antispasmodic properties and has long been associated with improvement of digestive function. Peppermint leaves contain oils that have mild anesthetic properties, relieve nausea, and relax smooth muscle spasticity caused by histamine and cholinergic stimulation. 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 reduce IBS symptoms, 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 systematic review identified five trials that showed that peppermint oil relieved IBS symptoms. Three of these trials showed statistically significant benefit of peppermint over placebo (P < .001). The placebo response ranged from 13% to 52% with a mean of 31% including all five trials. 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.

Possible side effects:

• Peppermint oil should never be applied to the face or near mucus membranes.
• Peppermint oil may cause heartburn or stomach upset.
• Enteric-coated capsules may cause a burning sensation in the rectum.
• Peppermint may interact with Cisapride.
• Do not use this herb if:
  • You have chronic heartburn.
  • You have severe liver damage.
  • You have inflammation of the gallbladder.
  • You have obstruction of bile ducts.
  • You are pregnant.

Artichoke

Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in persons with IBS.

Do not take artichokes if you have a bile duct blockage. Artichokes can stimulate the flow of bile.

Scientific evidence of Artichoke effectiveness

• Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study. PubMed
• Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. PubMed
• Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. PubMed

Melatonin

Melatonin is a promising therapeutic agent for IBS. Its therapeutic effect is independent of its effects on sleep, anxiety or depression. Melatonin is involved in the regulation of gastrointestinal motility and sensation.

Three small studies suggest that use of the melatonin supplement might reduce symptoms of IBS. It has been suggested that the hormone melatonin may have an effect on the nervous system in the digestive tract.

Administration of melatonin 3 mg at bedtime for two weeks significantly attenuated abdominal pain and reduced rectal pain sensitivity without improvements in sleep disturbance or psychological distress. The findings suggest that the beneficial effects of melatonin on abdominal pain in IBS patients with sleep disturbances are independent of its action on sleep disturbances or psychological profiles.

Scientific evidence of Melatonin effectiveness

• Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. PubMed
• A preliminary study of melatonin in irritable bowel syndrome. PubMed
• Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. PubMed
• Gastrointestinal melatonin: localization, function, and clinical relevance. PubMed

Padma Lax

Padma Lax is a safe and effective treatment for constipation-predominant irritable bowel syndrome and may offer an alternative to the current multi drug approach.

Scientific evidence of Padma Lax effectiveness

• A novel treatment for constipation-predominant irritable bowel syndrome using Padma Lax, a Tibetan herbal formula. 3-month double-blind randomised pilot study. PubMed

Aloe Vera

Scientific evidence of Aloe Vera effectiveness

• Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. PubMed

Ginger

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

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 anllergic skin reactions. Consult your doctor before taking ginger if you take blood thinners such as warfarin (Coumadin). Ginger can increase the risk of bleeding.

Possible side effects:

• Some people may experience heartburn from the strong taste.
• High doses of ginger (6 grams or more) can cause damage to the stomach lining and ulcers.
• Ginger can cause anllergic skin reactions.
• Do not use if:
  • You have bile duct obstruction or gallstones.
  • You are pregnant.
• Drug Interactions:
  • May reduce the effects of major anesthetics.
  • May reduce the effects of Chemotherapy drugs.
  • May have an adverse reaction with Heparin.
  • May interact with Ticlopidine.
  • May have an adverse reaction with Warfarin (Coumadin).

Scientific evidence of Ginger effectiveness

• No human studies have been performed on Ginger in relation to IBS.

Chamomile

Chamomile is known to soothe the digestive tract as an anti-spasmotic and anti-inflammatory agent. Chamomile is sometimes used by herbalists to relieve alternating bouts of diarrhea and constipation. 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.

While no human studies have been performed on this supplement in relation to IBS, it has been proven to reduce irritation and cramping in animals with IBS.

Scientific evidence of Chamomile effectiveness

• No human studies have been performed on Ginger in relation to IBS.

Digestive enzymes

Digestive enzymes are substances designed to break down foods 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 are available at all health food stores and may be of more benefit to older people, as natural digestive enzyme production declines with age.

Bromelain

Consult your doctor before taking bromelain if you are taking anticoagulants or antithrombotic agents. Bromelain can thin the blood. It can also cause gastrointestinal symptoms such as nausea and diarrhea; bleeding from the uterus between menstrual periods (metrorrhagia) and excessive uterine bleeding during menstruation (menorrhagia).

Evening Primrose Oil (Oenothera biennis)

Many women with IBS report that symptoms are worse during their menstrual period. Evening primrose oil may help to improve symptoms, especially in women who experience a worsening of pain, discomfort, and bloating during their menstrual period.

In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking enough evening primrose oil (EPO) to provide 360–400 mg of gamma linolenic acid (GLA) per day. In that trial more than half reported improvement with EPO, but none was helped in the placebo group. The effects of EPO in other groups of IBS sufferers have not been explored.

Turmeric (Curcuma longa)

Scientific evidence of Turmeric effectiveness

• Turmeric extract may improve irritable bowel syndrome symptomology in otherwise healthy adults: a pilot study. PubMed

Acupuncture

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

Hypnotherapy

Hypnosis for relaxation has dramatically and consistently relieved symptoms of IBS in some people. Perhaps the benefits of hypnotherapy lie with the relaxation and de-stressing that occurs for patients receiving the therapy.

Irritable bowel syndrome can be lastingly treated by hypnotherapy, a study says. A long-term survey of more than 200 patients with this condition found that 71 per cent responded well to hypnotherapy and averred that the improvement lasted for at least five years. The patients underwent one-hour hypnotherapy sessions that lasted up to 12 weeks. They were quizzed about their symptoms, quality of life and mood before, immediately after and up to six years following their treatment. Their improvement was so good that less than 10 per cent of the patients bothered to seek alternatives to hypnotherapy afterwards.

Gut-directed hypnotherapy results in significant, long-term improvements in symptoms of irritable bowel syndrome.

• Hypnosis May Be Useful IBS Treatment