Combination of Therapies Offers Help for IBS

Last Editorial Review: 1/31/2005

Combining conventional and complementary therapies may provide relief for irritable bowel syndrome sufferers.

By Carol Sorgen
WebMD Feature

Reviewed By Brunilda Nazario

If you -- like more than 50 million Americans -- suffer from irritable bowel syndrome (IBS), you know all too well the symptoms of the disorder: abdominal bloating, gas, cramps, diarrhea, and/or constipation.

IBS is a functional disorder one which has no anatomical or structural abnormalities. While there is no identifiable chemical or physical problem it can wreak havoc in your everyday life. Unfortunately, there is no cure for IBS, but there are therapies available to make coping with the situation easier.

Medication and Dietary Changes

Conventional treatment for IBS may involve medication and dietary changes, says gastroenterologist Joseph Brasco, co-author of Restoring Your Digestive Health. Prescription medication to relieve spasm for people with abdominal pain, such as Bentyl and Levsin, relaxes the muscle and prevents spasms from occurring and are prescribed frequently for IBS to help with diarrhea.

For those whose IBS is accompanied by constipation laxatives and fiber are frequently recommended. The medication Zelnorm may also be prescribed. Zelnorm acts to mimic a natural occurring hormone called serotonin which helps increase motility throughout the gastrointestinal (GI) tract. While studies have focused on the use of Zelnorm in women, there appears to be no reason it cannot be used for men with IBS as well, says Brasco.

Dietary changes play a significant role in managing IBS, says Brasco. Many people with IBS are either lactose- or fructose-intolerant. Dairy products, and foods and beverages (such as soda) sweetened with fructose can trigger episodes of diarrhea and should be limited.

Other sugars such as maltose and sucrose can also aggravate IBS. These sugars -- found in foods such as bread, pasta, rice, and potatoes -- are hard to digest, says Brasco. They pass into the bowel undigested where they are used by intestinal bacteria and this can lead to gas, bloating, and cramps (and research shows, to acid reflux as well). "Reducing these foods in your diet can make a difference," Brasco says.

What you should eat is lots of fiber, says Brasco. "Fiber is the cornerstone of dietary management, because it regulates the bowel," he explains. Fiber reduces IBS symptoms -- especially constipation. Examples of high-fiber foods are apples, peaches, raw broccoli, raw carrots, cabbage, kidney beans, and whole-grain cereal.

Dietary Supplements

Brasco also recommends dietary supplements for his IBS patients, specifically digestive enzymes and probiotics. Digestive enzymes -- which usually contain such ingredients as amylase, lactase, protease, and lipase -- enhance the digestive process, easing not only the symptoms of IBS but also chronic indigestion. They can be found in health food stores and some pharmacies (or direct-to-consumer through pharmaceutical companies), and can be bought without a prescription.

Probiotics are important to intestinal health for changing intestinal flora. Probiotics are dietary supplements containing friendly bacteria. The scientific literature regarding the benefits of probiotics is "mixed," says Brasco, but among his own patients he says they are "invaluable."

Kelly Dowhower Karpa, PhD, RPh, assistant professor in the department of pharmacology at the Pennsylvania State University College of Medicine, and author of Bacteria for Breakfast, says that probiotics replace the "bad" bacteria in your intestines with "healthy" ones, and have been used to successfully treat both constipation- and diarrhea-predominant IBS.

"Ideally, we'd eat enough healthy bacteria in our diets through fermented foods (miso, kim-chee, sauerkraut, beet juice, etc.) like our ancestors did," says Karpa. "But since most of us don't eat that healthy, we can use probiotic supplements to fill in the gaps."

Most probiotics should be taken one hour prior to meals, or two to three hours after meals, Karpa advises.

"If a patient is extremely immunocompromised, probiotics should be used cautiously," says Karpa. "Otherwise, there are really no adverse effects, with the possible exception of feeling a little gas within the first week of taking them. Although annoying, the gas is actually a good thing since it means the 'bad' bacteria are dying off."

For relief of cramps, Brasco also suggests peppermint for its antispasmodic effects, taken as a tea, tincture, lozenge, or oil (put a drop or two on your tongue). Chamomile is another herb with antispasmodic properties, Brasco says.

A new treatment for the dietary management of IBS is a medical food, known as Digestive AdvantageT IBS, which is a blend of the bacteria lactobacillus with proteins that normalizes intestinal bacteria and aids digestion of dairy, fruits, meats, and carbohydrates. Developed by Ganeden Biotech, Digestive Advantage is an "ongoing management tool," says chief scientific officer Sean Farmer, MS.

Stress Reduction

Another essential part of treating IBS is stress management, says Jay Winner, MD, author of Stress Management Made Simple: Effective Ways to Beat Stress for Better Health. "Stress tends to make IBS worse," says Winner. Relaxation exercises that use "diaphragmatic breathing" seem particularly effective in improving the symptoms of irritable bowel syndrome. To practice such an exercise, he says, gently let your abdomen expand with each breath in. As thoughts arise, let them go and focus back on your breath.

Other stress-reduction remedies range from a simple walk around the block -- recommended by Brasco -- to yoga, meditation, biofeedback, and hypnosis. Herb Hamilton, CHT, has been treating IBS sufferers through both hypnosis and dietary management for more than 10 years. Hamilton recommends that his IBS patients eat five small meals a day, reduce the fat in their diet, and avoid alcohol, caffeine, and sodium, all of which, he says, can trigger episodes of IBS.

Hand-in-hand with the dietary management is the hypnosis. "Fifty percent of the battle in dealing with IBS is in stress management," says Hamilton, director of the Wellness and Fitness Institute in Tampa, Fla., and author of Mission Possible: A Therapist's Guide to Weight Loss with Hypnosis. "Stress and diet are IBS triggers."

Hamilton, who has been certified in irritable bowel hypnosis by the American Council of Hypnosis Examiners, uses traditional hypnotherapy techniques, which relax both the body and the mind, as well as specific mind-body suggestions that help clients visually see in their mind's eye improvement in their specific situation.

Traditional Chinese Medicine (TCM) may also be successful in treating IBS, says Noah Rubinstein, a licensed acupuncturist, Chinese herbalist, and faculty member of the New York campus of the Pacific College of Oriental Medicine. Herbal medicine, acupuncture, diet, exercise, and stress reduction are all part of IBS therapy, says Rubinstein.

Herbal formulas are aimed at fortifying and supporting the digestive system, says Rubinstein, who cautions against self-medicating with Chinese herbs. "Even seemingly inert substances can cause problems," he says. Because herbal formulas are crafted to meet specific patient needs, it's best to consult a TCM practitioner, Rubinstein advises.

Acupuncture can help those with IBS by easing the perception of pain, reducing stress, and improving the function of the liver, which regulates chi or energy, Rubinstein explains (the liver in traditional Chinese medicine does not have the same function as the liver in Western medicine, Rubinstein points out; if an acupuncturist says your liver is blocked or stagnant, that doesn't mean you have a serious illness, but rather, a blockage of energy).

Whether you rely on conventional therapy or complementary therapy or a combination of the two, most health care professionals who treat people with IBS agree with Rubinstein when he says, "IBS is not just about the intestines. You have to take into account the whole person."

Published July 8, 2004.

SOURCES: Noah Rubinstein, L.Ac., Pacific College of Oriental Medicine, New York campus. Sean Farmer, MS, chief scientific officer, Ganeden Biotech, Miami. Joseph Brasco, MD, author, Restoring Your Digestive Health. Herb Hamilton, CHT, author, Mission Possible: A Therapist's Guide to Weight Loss with Hypnosis, Tampa, Fla. Kelly Karpa, PhD, RPh, assistant professor, Pennsylvania State University College of Medicine, Hershey, Pa. Jay Winner, MD, author, Stress Management Made Simple: Effective Ways to Beat Stress for Better Health, Santa Barbara, Calf.

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