Studies show some natural alternatives relieve symptoms for irritable bowel syndrome
By Martin F. Downs
WebMD Weight Loss Clinic - Feature
Reviewed By Brunilda Nazario, MD
Many people turn to natural treatments to relieve symptoms because there is no one treatment for irritable bowel syndrome (IBS) that works for everyone, and because scientists have yet to pinpoint the exact cause of the condition. Studies of some natural alternatives have had promising results, but none are proven.
Irritable bowel syndrome is not a disease. As the name implies, it is a syndrome -- a group of symptoms that fit a pattern. The main symptoms of IBS are problematic bowel movements, gut pain, and bloating. Some people who suffer from IBS have constipation, others have diarrhea, and some have both.
Before it was called IBS, the syndrome was usually known as "spastic colon." There is nothing physically wrong with the intestines of people with IBS, but the contractions that move food through the digestive tract may be disturbed. With IBS the nerves and the muscles in the bowel are extra sensitive. It's also thought that IBS sufferers may be particularly sensitive to the rumbling and burbling that goes on in the bowel during digestion. What you eat may play a role, too.
Christine Frissora, MD, a gastroenterologist at New York's Weill Medical College of Cornell University, says that before she writes a prescription to treat people who have the condition, she encourages IBS patients to try lifestyle changes. "They have to stop smoking, they have sleep, they have to eat properly, they have to exercise," she says.
You Feel What You Eat
When it comes to eating properly, some people find that cutting certain foods out of their diet helps. What you eat obviously has different effects on your bowel. Fluids also help stool pass regularly. "I always recommend water and soluble fiber -- meaning fibers that are gentle on the GI tract, such as oatmeal, berries, lentils, and split peas," Frissora says.
"Dietary modification, I always tell patients, needs to be individualized," says Philip Schoenfeld, MD, a gastroenterologist at the University of Michigan and spokesman for the American College of Gastroenterology. "Each patient tends to be a little bit different in terms of food or drinks that tend to spur their irritable bowel syndrome symptoms," he says.
For example, if your worst IBS symptom is pain caused by bloating, eating lots of beans and leafy greens wouldn't be best for you, because they cause gas. But if you primarily have trouble with constipation, then adding fiber to your diet may help. Frissora points out that there is a difference between soluble and "crude" fiber. Crude fiber includes bran and the skins of vegetables such as eggplant and bell pepper. These things can be irritants and don't help.
Other commonly reported triggers for IBS symptoms include:
- Dairy products such as milk and cheese
- Fatty foods such as French fries
- Caffeine found in coffee and some sodas
- Carbonated drinks such as soda
Probiotics: In With the Good
Some people may begin to have IBS symptoms in the wake of an intestinal infection such as Salmonella. It's not that the infection causes the IBS, but "somehow that seems to affect the normal motility of their small intestine and their colon," Schoenfeld says.
It's possible that an infection changes the types and amounts of bacteria normally present in your intestines, upsetting digestion. Probiotics are natural supplements that promote the growth of healthy bacteria that aid digestion. "Instead of killing bacteria, you're putting something in that will allow healthy bacteria to flourish," Frissora says.
Taking probiotics may help IBS sufferers who can pinpoint the start of their problems on a recent case of food poisoning or gastroenteritis. "That may be where the probiotics are more effective," she says.
Two examples of probiotics are Saccharomyces boulardii and Lactobacillus acidophilus. S. boulardii is a yeast culture, sold in capsules by the brand name Florastor. L. acidophilus is a bacterium that can be found in yogurt, and is also available as a supplement in pill or powder form. These probiotics have been widely studied as treatments for various digestive problems, but there have been few studies done specifically for IBS.
Several studies have looked at the use of acupuncture as an alternative way to ease IBS symptoms, and the results have been generally promising. Although it's still not a proven treatment, Frissora says she thinks it is worth trying when all else fails.
Acupuncture probably doesn't fix diarrhea or constipation, but it may help with discomfort caused by gas. "If the patient has more of the pain-bloat IBS, they might respond better to acupuncture because that would mediate the pain," Frissora says.
If IBS pain is caused by a special sensitivity of the enteric nervous system -- the nerves that wire the brain to the gut -- acupuncture could perhaps alter the signals the brain reads as painful sensations.
"I think that a lot of the success of acupuncture depends upon who's doing it and how much experience they have with IBS," she says. She recommends checking with your insurance company to find out if there is an acupuncturist on the plan.
In a study published in the American Journal of Gastroenterology, Schoenfeld looked at the studies done to date on several natural fiber supplements, or stool "bulking agents," used in treating IBS. These included:
- Wheat bran
- Corn fiber
- Calcium polycarbophil (brand name Fibercon)
In general, the studies showed that fiber supplements helped with constipation. They were not, however, much better for other IBS symptoms compared with a placebo.
The Mind-Gut Connection
IBS is not caused by stress, but many people say it aggravates their symptoms. Exercise is one of the best ways to relieve stress.
Alternative practices such as yoga and tai chi are known to help people cope with stress, but they haven't been studied as way of managing IBS. Nevertheless, Frissora says they can't hurt. "I think that any exercise is good for IBS," she says. "I tell patients, I don't care what kind of exercise you want to do." Walking, running, and swimming are good, too.
What's more, Schoenfeld says, "If you exercise regularly, the frequency of your bowel movements will increase. If you can get people with irritable bowel syndrome to have a more regular pattern of moving their bowels, that usually provides some relief for their IBS symptoms."
Behavioral therapy is sometimes considered for people with IBS, although the syndrome isn't merely a product of one's mind. A number of studies have shown that many kinds of behavioral therapy can help IBS symptoms, including:
- Relaxation therapy
- Hypnosis therapy
- Cognitive therapy
The studies that Schoenfeld reviewed for the American Journal of Gastroenterology showed that these things worked, but he could not say for certain that they are proven beyond any doubt because of problems with how the various studies were done.
Frissora says she thinks hypnotherapy is best suited to people whose IBS is worsened in anxiety-inducing situations such as public speaking or flying on a plane. She says she thinks psychotherapy is most helpful for people who feel that their IBS symptoms are related to an emotional trauma.
Published March 29, 2004.
SOURCES: Philip Schoenfeld, MD, assistant professor, University of Michigan School of Medicine; spokesman, American College of Gastroenterology. Christine Frissora, MD, assistant professor, Weill Medical College of Cornell University, New York. American Journal of Gastroenterology, 2002.Comprehensive Therapy, 2002. National Digestive Diseases Information Clearinghouse web site. National Library of Medicine web site.
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