People with irritable bowel syndrome (IBS) often suffer from various signs and symptoms relating to the gastrointestinal syndrome. IBS is a functional bowel disorder that is not related to any structural or biochemical problems in the body, and leads to abdominal pain and discomfort, bloating, and diarrhea or constipation. Though in some people, IBS may have mild to moderate symptoms, in some individuals, it can be debilitating and and can even lead to other medical problems such as overactive bladder, migraine, depression and anxiety.1

The prevalence of IBS is high and can affect quality of life in many people, as compared to diabetes and hepatitis. IBS can be due to many factors and its mechanism and molecular pathophysiology are complex.  A few modifications that are responsible for this disease have been depicted, like sensitivity of gastrointestinal organs, changes in the brain, bowel movements, secretory dysfunctions, and physical as well as and mental comorbidities. Moreover, gastrointestinal problems such as immune system hyperactivity, gut dysbiosis or microbial imbalance, weakened mucosal functions, nerve sensitivities, infections, altered immune substances and altered genes, have been related to IBS.1

Since IBS is a common disease with no known causes and treatments, the quest for alternative treatments for this condition is on.

Why Nutrition is Important in IBS

IBS management needs an integrative approach that consists of the establishment of a successful patient– medical doctor relationship, education, dietary modifications, medications and psychological treatments. Among these approaches, nutritional interventions and psychotherapy are the ones that are important for all types of IBS.2

Nutrition is actually one of the common factors that leads to the symptoms that are felt by people with IBS. Symptoms after eating and fear of these symptoms can actually decrease quality of life. 3

It has turned out that food intolerance and not food allergies is actually the main reason behind IBS adverse symptoms to certain foods. However, this does not imply that immune response to food is not related to IBS, as exposure to food antigens have been proven to change the ultrastructure of the duodenal lining by some studies. Also, immune response to gluten is also present in people with IBS who have no celiac disease.4

Fiber and fiber-based foods enhance colonic movements, increase stool mass and encourage its passage, bringing about increased stool frequency. These effects bring about significant advantages to individuals with IBS. Fiber and its derivatives are able to treat the symptoms of IBS.5

As to medicines, they are of limited advantage to IBS. Tricyclic antidepressants show promise, but these medicines, as well as selective serotonin reuptake inhibitors and antispasmodics may have potential risks and side effects. Thus, because they are dissatisfied with current drugs and because of better overall care, about 50% of people with IBS are now turning to complementary and alternative medicine treatments.6

Here are some of the alternative treatments for IBS, as outlined by the study of Shen and Nahas in 2009. 7

Treatment Results References
Peppermint oil Overall symptom improvement with peppermint oil Pittler et al, 19988

Spanier et al, 2003 9

Probiotics Improvement in global IBS symptoms and abdominal pain compared with placebo. McFarland et al, 2008 10
Soluble fibre Improvement of global IBS symptoms, especially in IBS-related constipation, but no improvement in abdominal pain.

 

Soluble but not insoluble fibre improves constipation and global IBS symptoms.

Bijkerk et al, 2004 11
Tong xie yao fang More effective than placebo Bian et al, 2006 12
Hypnotherapy Greater decline in symptom scores at 3 months.

 

Benefit in children with functional abdominal pain or IBS

Webb et al, 2007 13

Gholamrezaei et al, 2006 14

Wilson et al, 2006 15

Whitehead et al, 2006 16

Cognitive behavioral therapy 12 weekly sessions improved symptoms more than education did.

 

Symptoms and well-being improved more with CBT.

Drossman et al, 2003 17

Boyce et al, 2003 18

Kennedy et al, 2005 19

Van Dulmen et al, 1996 20

Blanchard et al, 2007 21

 

Table 1: Summary of evidence for complementary and alternative treatments for IBS. Taken from Shen and Nahas, 2009.

Fibre

IBS patients are often advised by doctors to increase their fiber intake through diet or food supplements. This was due to the results of a clinical trial that show benefits in patients with IBS. 22 However, it seems that only soluble fiber is more effective, but more evidence is lacking. Soluble fiber is in the form of psyllium, which is found in whole grains, and may also be found in fruits and vegetables. Psyllium forms a gel when exposed to water and is acted upon by gut bacteria to yield metabolites that decrease pressure within the colon and gut transit time.

There are many studies that have examined the effects of fibre in the treatment of IBS. In some of these clinical trials, the investigators failed to show any benefits on abdominal pain by wheat bran and soluble fibre, though there was relief of global symptoms of IBS, especially in constipation.23 To summarize the findings, soluble fiber can relieve constipation in IBS as well as global IBS symptoms, but there is still less evidence that it can relieve abdominal pain. Also, the findings in these studies were limited by several factors because the investigators did not screen the subjects for other conditions such as celiac or gluten sensitivity, small intestinal bacterial overgrowth (SIBO) or lactose intolerance.24

Peppermint oil

This is an oil extract from the peppermint plant (Mentha piperita Linnaeus) that has been utilized to treat stomach pain for many years. It seems to relax the intestinal smooth muscle cells by acting on calcium channels.25 Peppermint oil seems to mitigate IBS symptoms, including abdominal pain. However, its capsules should not be chewed because they are enteric coated, as gastroesophageal reflux may occur.26

Studies have shown that peppermint oil capsules can bring about overall symptom improvement. In one of these studies involving 110 subjects, the subjects where screened for SIBO, lactose intolerance and celiac disease. Next, they were asked to take 4 peppermint oil capsules daily for 4 weeks. IBS symptoms improved in 75% of the subjects and compared to 38% of subjects who took the placebo.27

Side effects of peppermint oil include nausea and burning of the perianal area. The safety of peppermint oil on pregnant women was still not established.28

Herbal formulas

The mixing of some digestive herbs to accomplish positive effects in IBS is a typical practice in traditional medicine.

Tong xie yao tooth (TXYF) is one such formula that is used by Chinese herbalists.  TXYF is said to be more effective in IBS than placebo.29 Another Tibetan herbal formula known as Padma Lax has been made and utilized in Europe for many years. One study was able to show efficacy of the said formula.30

Other herbal formulas are STW 5 and STW 5-II which contains several herbs that are commonly used to aid digestion. A study has demonstrated that pain and symptoms were improved by subjects with IBS who took STW.31 A Cochrane systematic review showed that TXYF, Padma Lax, and STW 5 improved IBS symptoms as compared to placebo.32

However, safety is an issue with these supplements. A systematic review that contained data from 22 clinical trials have shown that subjects who took these herbal medicines experienced adverse events, but all of them were not serious. However, the authors of this systematic review have noted that these trials were not done with good quality and may have adverse events that were not properly documented and reported.33

Probiotics

Probiotics, known as one of the supplements for IBS, are composed of live microrganisms that, when ingested in sufficient quantities, have health advantages on humans. Probiotic-rich foods like yogurt, kefir, miso, tempeh, and sauerkraut have been used by people for many years.34

Probiotics seem to act in different ways that are not yet totally comprehended. They change the environment of the gastrointestinal mucosa, delivering useful short-chain unsaturated fatty acids and deconjugating bile acids, and stop the growth of disease-causing microorganisms by competing with them. They additionally have powerful effects against inflammation by controlling the expression of cytokines by connecting with gut lymphoid tissues. These immune effects change the sensitivities of the gastrointestinal organs and likewise affects the symptoms and progression of IBS.35

Some studies concerning probiotics have noted the improvement of IBS symptoms and abdominal pain. However, evidence was limited with the different organisms, doses and strains that were used. The common strains used in these studies were Lactobacillus and Bifidobacterium. There is still insufficient research as to what strain is the most effective in treating IBS symptoms.36

Probiotics may be taken as a powder or as capsules. Side effects such as bloating and gas are usually minimal and transient. The most common oral dosage for probiotics is 10 to 100 billion bacteria.

Hypnotherapy

Since the ancient times, mind-body techniques such as hypnotherapy have benefited many people. Hypnotherapy that is directed towards the gut is a different method that combines the benefits of relaxation and emotional well-being with gut health. Its utilization in IBS was first mentioned in a small study consisting of only 30 patients, in which there was improvement in symptoms after just 7 weekly sessions of hypnotherapy than what was observed with psychotherapy.37

A systematic review of hypnotherapy use in IBS showed positive results. In a large study, 81 subjects with IBS had 5 weekly sessions of hypnotherapy and used a self-hypnosis audiotape everyday. They had decreased IBS symptoms at 3 months.38 Also, in one study, children with abdominal pain or IBS were also relieved after hypnotherapy.39 However, experts warn that people with IBS should seek treatment with a therapist who has extensive training in gut-directed hypnotherapy.

Cognitive-behavioural therapy

Patients who have experienced cognitive behavior therapy or CBT are prepared to perceive and align properly their thoughts and practices that intensify symptoms or determine their health and well-being. This treatment method may be combined with mental techniques for adapting to symptoms of IBS.40

Psychological treatments may be considered for most patients with IBS, yet the exact intervention that may be utilized can rely upon numerous factors, including the preference of the patient, cost, and the availability of the therapists in the area. Health professionals who are trained in CBT can consider rendering their services to IBS patients. Hypnotherapy may be prescribed if it is present in the area, yet therapists who are trained in different modalities may likewise be considered as integrative therapy providers who may deal with IBS treatment.41

Acupuncture

Acupuncture is an alternative and complementary medicine treatment that has been used to treat some gastrointestinal complaints in both physical and secondary cases, and has been appeared to affect gastrointestinal reflex actions, gastric movements, and acid secretion. In IBS, there is a brain-gut disturbance, making acupuncture an alternative method that can be considered in treating IBS.42

Conclusion

Current medications can bring about insufficient help in IBS symptoms, driving numerous patients to think about alternative treatments. Peppermint oil and probiotics are bolstered by enough evidence to suggest their utilization. Hypnotherapy and CBT are additionally helpful treatment methods and there is enough evidence that they may benefit people with IBS. Soluble fiber can provide relief to constipation in IBS, yet it may not be as effective in abdomibal pain. Some herbal formulas have limited evidence as to their efficacy, yet health professional should think about their quality and purity before prescribing them to patients.

Doctors should screen for parasitic diseases, gluten sensitivity, SIBO, and lactose intolerance before diagnosing a person to have IBS. They may ask about current and past use of alternative treatments and encourage patients to converse more about the alternatives they are thinking about. This can possibly boost doctor-patient relationships, which may likewise make IBS treatments more effective.

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