Bloating. Abdominal discomfort. Diarrhea or constipation. Irritable bowel syndrome (IBS) certainly is no fun, but in industrialized nations, it affects 10 percent to 15 percent of the population–about 30 million Americans. It’s the most common functional gastrointestinal disorder, in which the bowel looks normal but functions abnormally. Specifically, the large bowel contracts too much and in a disorganized fashion. IBS more frequently plagues women than men.
Doctors diagnose the condition based on a patient’s reported symptoms. Although there is no test for IBS, tests might be run to exclude other diseases, such as lactose intolerance, pancreatic insufficiency, celiac disease, parasitic infection and bacterial overgrowth of the small intestine. Multiple factors can contribute to the development of IBS: childhood trauma, psychological stress, intestinal infection and inflammation, altered intestinal bacteria, disturbances in nerve and hormone function, food sensitivities and allergies.
Conventional medical treatment includes antidepressants (to relieve accompanying anxiety, depression and pain); antispasmodics to relieve pain and bloating; drugs that modulate intestinal serotonin; opioids for severe pain; drugs like Imodium (loperamide) for diarrhea; fiber and laxatives for constipation; and a short course of antibiotics for intestinal bacterial overgrowth. In a 2004 review of drug management of IBS published in the International Journal of Clinical Practice, the authors say, “The therapeutic management of the irritable bowel syndrome (IBS) is ineffective and not satisfying either patients or practitioners.” After describing new medications, they added, “Questions remain whether a single therapy is sufficient in the management of IBS because this disease is influenced by biological and psychological as well as cultural and social factors.”
Patrick Hanaway, M.D., is the chief medical officer of Genova Diagnostics in Asheville, North Carolina, and the author of several articles on IBS. Hanaway believes the key to successful treatment requires a holistic evaluation and treatment approach. In other words, no magic bullet cures IBS. A practitioner must help identify which of the many disturbances in bowel function underlies a person’s IBS symptoms, then formulate a treatment protocol that restores balance. And healing is attainable. According to Jillian Stansbury, N.D., chair of the botanical medicine program at the National College of Natural Medicine in Portland, Oregon, “IBS is a condition that responds very well to complementary and alternative therapies.”
Diet for a Calm Colon
Stansbury notes that a subset of people with IBS have underlying food allergies. Her tip-off is that the person also has a history of asthma, eczema or hay fever. Hanaway recommends testing for food allergies and sensitivities with either a blood test or an elimination-challenge diet. In the latter, you have to eliminate potentially allergenic foods from the diet (e.g. milk, wheat, eggs, nuts, peanuts, shellfish, soybeans and oranges). Because it takes time for the bowel to recover from the inflammation caused by food intolerance, Stansbury encourages her patients to stay off allergenic foods for two months before the challenge of reintroducing foods one at a time and observing reactions.
Some foods aren’t allergenic but still can provoke IBS symptoms. They include caffeine, alcohol, fatty foods, gas-producing vegetables (legumes and cruciferous veggies), fructose and sorbitol (sweeteners in many beverages, foods and candies). Keeping a food diary will help you identify culprit foods and food additives.
Though it’s a tedious process, finding the foods that generate gut misery can be worthwhile because removing the offending foods can relieve symptoms. Christina Bertelli, a clinical herbalist at Apothecary Tinctura in Denver, says using herbs and probiotics (see more below) helped her symptoms, but eliminating dairy is what finally put her IBS to rest.
Some foods can improve symptoms. Fiber is one. Whereas insoluble fiber (as from corn and wheat bran) can worsen IBS symptoms, soluble fiber can help relieve constipation. Food sources of soluble fiber include psyllium seed husks, oats, flaxseeds (Linum usitatissimum), barley, apples and carrots. Bertelli’s favorite fiber source for IBS is flaxseeds, which also provide anti-inflammatory fatty acids. Grind flaxseeds fresh and stir a tablespoon a day into a glass of diluted juice. When consuming extra fiber, drinking plenty of fluids is key.
The Mind-Body IBS Connection
Manage stress. Stress and anxiety play big roles in IBS. Stansbury finds that people with IBS often have more muscle tension, chronic headaches, anxiety and fibromyalgia. These patients often report that added life stress worsens their IBS. For them, Stansbury recommends meditation, stress management with a psychologist, and herbs that calm the nervous system and intestinal tract.
Relaxation response meditation changes the emotional and physical responses to stress and provides relief from IBS. To try it at home, find a quiet place and sit comfortably with your eyes closed. Mentally scan your body for places you might be holding tension. Breathe and try to release that tension. Begin silently repeating a mantra or phrase. When your mind wanders, gently bring your attention back to your breath and your mantra. Gradually work up to practicing your meditation 20 minutes a day.
Cognitive behavioral therapy–psychotherapy that helps restructure habits of thought and behavior–has indeed been shown to improve IBS. IBS symptoms can adversely change a person’s life. The person might worry about their symptoms (especially diarrhea), fear embarrassment in social situations, and restrict activities. Not surprisingly, self image and social satisfaction can erode, as can achievement at work, school and adherence to a fitness
regime. Therapists can help a person cope with the stress of having IBS, bolster self-esteem and solve some of these problems. Because stress can aggravate IBS, cognitive behavioral therapy theoretically can help people manage any type of stressor and therefore improve the course of this syndrome.
Another mind-body therapy called gut-directed hypnotherapy has been shown to reduce IBS symptoms. Treatment generally involves a dozen weekly sessions in which a therapist guides a person into a hypnotic state, makes suggestions relevant to the person’s life, and teaches the person to bring a sensation of warmth to the abdomen using the hands and imagery. Several studies have shown immediate relief. One 2003 study found that 71 percent of volunteers responded to therapy, and of those responders, 81 percent experienced continued relief when contacted six years later.
Mild-to-moderate exercise offers at least two benefits for people with IBS. One, it provides an outlet for stress. Two, it seems to reduce intestinal gas and bloating. Aim for 30 minutes most days of the week.
Supplements to Try
Probiotics are microorganisms considered beneficial for bowel health. This family of friendly flora is huge and not all members seem to benefit IBS. Promising strains include Bifidobacterium infantis, B. breve, Saccharomyces boulardii and Lactobacillus plantarum. Hanaway recommends a mixture of equal parts L. plantarum and B. breve at a dosage of 25 billion colony-forming units (cfu) twice a day for six to eight weeks, then 10 billion cfu a day.
Hanaway says it’s also helpful to take prebiotics–the simple carbohydrates, such as inulin and fructooligosaccharides (FOS), that bowel flora feed on. Bertelli adds that two herbs–dandelion root (Taraxacum officinale) and burdock root (Arctium lappa)–not only support the liver and gut but are rich in inulin and make good additions to teas to soothe irritable bowels. One caveat is, if you have small bowel bacterial overgrowth, you should correct that problem (usually with antibiotics) before taking prebiotics.
Peppermint oil (Mentha ×piperita) has undergone extensive research for IBS. It’s antispasmodic, carminative (relieves gas), antibacterial and increases bile secretion. A 2005 review published in Phytomedicine examined the safety and effectiveness of enteric-coated peppermint oil capsules in both IBS and recurrent abdominal pain in children. Eight of 12 studies found that the herb was more effective than a placebo. Three studies found peppermint oil comparable to drugs that relax intestinal smooth muscle. Dosages ranged from 180 to 200 mg three times a day. Side effects were mild and transient and included heartburn and burning around the anus. Hanaway recommends one to two enteric-coated capsules three times a day between meals. He notes that products without the protective enteric coating could break down in the stomach, resulting in esophageal reflux.
Promising Herbal Options
Bertelli likes another mint-family member, lemon balm (Melissa officinalis) because it relaxes intestinal smooth muscle and the mind. Fennel (Foeniculum vulgare), licorice (Glycyrrhiza glabra), chamomile (Matricaria recutita) and ginger (Zingiber officinale) often are used singly or in combination with other herbs, such as peppermint, to manage symptoms. Fennel soothes intestinal spasms and eases gas and bloating. Use it in food, tea or tinctures. Licorice acts as a demulcent, meaning it coats and soothes irritated mucous membranes, and is a potent anti-inflammatory agent. Chamomile also is anti-inflammatory, plus it relaxes the nervous system and the intestinal tract. Ginger reduces nausea, unkinks intestinal spasms and improves the tone of intestinal muscles. Hanaway recommends 250 to 500 mg of ginger rhizome a day. You can take the ginger as a tea, capsule, syrup or grated into food.
Wild yam (Dioscorea villosa and other species) is Bertelli’s herb of choice for reducing painful intestinal spasms. Because the herb “tastes nasty,” she combines it with ginger as a decoction. To make, add to 2 cups of water 1 tablespoon each of dried, chopped wild yam root and chopped fresh ginger rhizome. Bring to a boil, simmer 30 minutes, strain and sip.
Artichoke (Cynara scolymus) is more than a mere culinary delicacy; it also quells a queasy stomach, protects the liver, reduces intestinal spasms and helps expel gas. A German study found that a standardized extract (Hepar-SL forte) significantly reduced IBS symptoms. Because the study lacked a placebo control, confirmatory research is needed.
Marshmallow (Althaea officinalis) is a premier demulcent. Bertelli recommends taking it as a cold infusion. Simply add 4 tablespoons to a quart jar or water bottle. Leave in the refrigerator for four to eight hours. Squeeze through muslin or cheesecloth. Drink a cup before each meal, sprinkling in cinnamon for taste as you like.
Stansbury also has had success with another demulcent herb–slippery elm (Ulmus rubra), especially when the inner bark is combined with other gut-friendly herbs in teas and capsules. (Because slippery elm is at risk for over-harvesting, buy from sources that harvest the plant ethically.)
A German herbal formula called Iberogast includes bitter candytuft (Iberis amara), peppermint, lemon balm, licorice, chamomile, angelica (Angelica archangelica), milk thistle (Silybum marianum), caraway (Carum carvi) and greater celandine (Chelidonium majus). Repeated studies have shown it to safely and effectively reduce symptoms of IBS and dyspepsia (a generic term for difficult digestion with discomfort, bloating, belching, nausea, heartburn and a feeling of fullness sooner than expected when eating). The ingredients reportedly reduce bowel inflammation, hypersensitivity and spasm, tone intestinal muscle and improve mucus secretion. A 2007 multicenter trial published in the American Journal of Gastroenterology found that 20 drops three times a day of Iberogast provided significantly more relief than the placebo treatment.
A 1998 study published in the Journal of the American Medical Association demonstrated benefits with a 16-week trial of Chinese herbs. Researchers randomly assigned volunteers to one of three groups. Group one received a patent formula for “spleen qi deficiency and liver-spleen disharmony” that contained 20 herbs, including dang shen (Codonopsis pilosula), chai hu (Bupleurum chinense), magnolia (Magnolia officinalis), ginger, goldenthread (Coptis chinensis), Schisandra species, and Chinese licorice (Glycyrrhiza uralensis). Group two received an individualized herbal formula. Group three received a placebo. Both herb groups improved significantly. However, those in the patent formula group relapsed upon stopping the herbs. The people taking custom-tailored herbs enjoyed sustained improvement when researchers checked in on them 14 weeks later.
One research study of 80 people with constipation-predominant IBS showed benefits for the traditional Tibetan herbal formula Padma Lax. It contains 15 herbs and minerals, including laxatives, such as aloe (Aloe vera), cascara sagrada (Rhamnus purshiana) and turkey rhubarb (Rheum palmatum), plus anti-diarrheal and antispasmodic herbs, such as ginger. Bertelli and Stansbury feel that the harsh laxatives in this compound may aggravate sensitive intestinal tracts. Hanaway only recommends this formula to people with constipation-type IBS.
Sometimes a warm bath or the application of warm oil can reduce intestinal cramping. If you want to make use of plant essential oils, Bertelli votes for marjoram. A remedy she finds helpful is a castor oil hot pack. Soak a piece of wool flannel with a blend of 2 drops marjoram essential oil in 1 tablespoon castor oil. Lay the cloth over your belly, then layer that with a sheet of plastic wrap, then a hot water bottle, then a towel. Shelley Torgove, clinical herbalist and owner of Apothecary Tinctura in Denver, says that warmth alone helps. She also finds abdominal massage helpful and says, “Abdominal massage solves half of the problems just by touching.”
Linda B. White, M.D., is an assistant professor in the Integrative Therapeutic Practices Program at Metropolitan State College of Denver and the coauthor of The Herbal Drugstore (Rodale, 1999) and Kids, Herbs, & Health (Interweave, 1998).
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