Irritable Bowel Syndrome (IBS)
Targeted Natural Interventions
Immediate Relief from Constipation-Predominant IBS
Some cases of IBS of the constipation type are caused by insufficient peristalsis, which means there is not enough colon contractile activity to completely evacuate the bowels (Grassi 2011). Instead of reverting to laxatives, there are specific nutrients that, if taken at the right time, can induce healthy colon peristaltic action without producing adverse effects.
On an empty stomach, certain nutrients will induce powerful colon peristalsis. One combination is taking several teaspoons of a buffered vitamin C powdered mix that contains in each teaspoon, 4,000 mg of vitamin C, 365 mg of potassium, and 55 mg of magnesium. The powder should be mixed in eight ounces glasses of water or the juice of a freshly squeezed grapefruit and wait for the fizzing to stop before drinking. This convenient product sold by several vitamin companies contains magnesium and potassium salts mixed with ascorbic acid which induces an evacuation of bowel contents within 30-90 minutes. Depending on the person, a few teaspoons (or, in some cases, 1 to 2 tablespoons) of this buffered vitamin C powder can produce a powerful but safe laxative effect.
Another popular approach is to use one teaspoon of an effervescent powder containing 4500 mg of ascorbic acid and 250 mg of magnesium carbonate that will evacuate the bowel within 30-90 minutes if taken on an empty stomach with several glasses of water. In either case, the dose should be adjusted individually based upon your response: if you experience diarrhea, reduce the dose.
Nutritional laxatives such as ascorbic acid mixed with magnesium and potassium salts are becoming more popular with people who have constipation that is resistant to fiber therapies.
Peppermint oil/ Caraway oil
Peppermint oil is a natural antispasmodic. In one study, an enterically-coated preparation of 225 mg peppermint oil taken twice daily was shown to reduce all IBS symptoms by over 50% in three-fourths of the patients, whereas only 38% of the placebo group improved (Cappello 2007). In another well-designed study, 187 mg of a similar peppermint oil product taken 3 times daily for 8 weeks led to a significant improvement over placebo with regard to abdominal discomfort, abdominal pain, and quality of life, but not in terms of diarrhea, constipation, or bloating (Merat 2010). IBS patients treated with peppermint oil in yet another study reported benefits including decreased abdominal pain, less bloating and flatulence, decreased stomach growling, reduced stool frequency, and improved stool consistency (Liu 1997).
In a clinical study using a fixed combination of peppermint and caraway oil, 45 patients with non-ulcer dyspepsia, the majority of whom had IBS, were studied in a double-blind, placebo-controlled trial. The test group took one enteric-coated capsule 3 times daily for 4 weeks. While all patients complained of moderate to severe pain before treatment, 42% of the patients in the test group were pain-free 2 weeks after taking the combination therapy. Only one patient in the placebo group reported freedom from pain. After 4 weeks of treatment, 63% of those that received the combination formula were pain-free compared to 25% in the placebo group; 89% showed improvement in the combination formula group versus 45% in the placebo group (May 1996).
Probiotics are microorganisms that may provide health benefits to their host when administered at sufficient levels (Ciorba 2012).
A pathogenic alteration in the gut microflora – dysbiosis – is one consistent finding associated with both IBS-D and IBS-C, which can cause or exacerbate IBS symptoms in a variety of ways (Carroll 2012; Chassard 2012). Dysbiosis is associated with increased intestinal permeability whereby pathogens, toxins, or undigested foods that are not usually absorbed are able to pass into the bloodstream. This can trigger abdominal pain and altered bowel habits (Barbara 2012). Dysbiosis can also lead to aberrant immune system activation, resulting in the release of cytokines that increase abdominal pain perception and alter bowel habits (Barbara 2012).
Dysbiosis associated with IBS produces an abnormally high amount of gas in response to certain foods, particularly those high in fermentable carbohydrates (Ong 2010). This results in an increase in abdominal bloating, abdominal pain, and flatulence that is reversed by avoiding those foods (Staudacher 2011). Probiotic supplementation may help rebalance intestinal flora and alleviate IBS symptoms.
A particularly important type of probiotic – bifidobacteria – is found in reduced quantities in the GI tracts of both IBS-C (Chassard 2012) and IBS-D (Duboc 2012) sufferers relative to healthy individuals (Balsari 1982). In one study, probiotic B. infantis 35624, in a dose of 10 billion colony forming units (CFUs), significantly improved abdominal pain/discomfort, abdominal bloating/distension, and difficulty with bowel movements in women with IBS after only 4 weeks (O'Mahony 2005). In a randomized clinical trial, IBS patients treated with 1 billion CFUs of bifidobacteria (a relatively low dose) experienced significant improvements in abdominal discomfort, bloating, and urgency relative to those who received placebo (Guglielmetti 2011). This treatment resulted in a significant improvement in quality of life and mental health (Guglielmetti 2011).
Another more robust finding supporting probiotic use in IBS comes from a study of the probiotic L. plantarum DSM 9843. In this study, 20 billion CFUs were administered daily for 4 weeks to IBS sufferers. Flatulence resolved rapidly, and improvements in overall GI function remained long after supplementation was discontinued (Nobaek 2000).
Collectively, these data suggest probiotics are effective in treating IBS, with strains of bifidobacteria being more favorable than lactobacilli, as lactobacilli are actually increased in certain populations with SIBO (Bouhnik 1999) and IBS (Tana 2010; Carroll 2010), correlating with worse symptoms (Rajilic-Stojanovic 2011).
Saccharomyces cerevisiae (S. cerevisiae) is a probiotic yeast that has a long history of use in fermented foods, including wine and sourdough (Hatoum 2012; De Vuyst 2014), and may be useful as a supplement in people with IBS. In a controlled trial, 179 people with IBS were treated with either 500 mg (4 billion CFUs) of S. cerevisiae per day or placebo. After eight weeks, 63% of subjects receiving S. cerevisiae reported reductions in abdominal pain and discomfort, while only 47% of subjects receiving placebo reported reductions in these symptoms (Pineton de Chambrun 2015). Findings from laboratory and animal studies suggest S. cerevisiae may exert its beneficial probiotic effects by protecting against intestinal pathogens, preventing intestinal hyperpermeability, and modulating the inflammatory response (Etienne-Mesmin 2011; Generoso 2010; Sivignon 2015). While S. cerevisiae has been shown to be safe in general, there are case reports of S. cerevisiae infections in susceptible people (Pillai 2014; Santino 2014); therefore, this probiotic should be used under medical supervision in immunocompromised individuals or those with chronic disease.
Artichoke leaf has been used since Roman times as a traditional medicine that supports digestive function. It has been shown to promote the production of bile that helps digest dietary fats and reduce spasms and flatulence. In one study, 2 capsules of 320 mg artichoke leaf extract taken 3 times daily almost completely eliminated abdominal pain, cramps, bloating, flatulence, and constipation in a population of IBS sufferers who also exhibited nonspecific GI discomfort or dyspeptic syndrome (Walker 2001). This was later confirmed and accompanied by a significantly improved quality of life in artichoke leaf extract-supplemented patients with functional dyspepsia (Holtmann 2003). In another study, consumption of 320 or 640 mg of artichoke leaf extract daily for 2 months significantly attenuated IBS symptoms and improved quality of life (Bundy 2004b).
Melatonin is a multifunctional hormone that exhibits a variety of beneficial effects in gastrointestinal disorders independent of its more widely known effects on sleep (Chen 2011). In one study of IBS patients with sleep disturbances, 3 mg of melatonin taken prior to bedtime for 2 weeks significantly decreased abdominal pain and rectal sensitivity (Song 2005). These findings were confirmed in a larger double-blind, placebo-controlled crossover study in which 3 mg of melatonin reduced abdominal pain and bloating in women with IBS (Lu 2005). In a study that examined a wider array of symptoms, besides improving bowel function, melatonin was also associated with a marked reduction in lethargy in a group of IBS sufferers (Saha 2007).
Perilla Leaf Extract
Perilla frutescens is a plant in the mint family that is native to East Asia. Its leaves are rich in polyphenols and, in addition to being a flavorful and aromatic ingredient in many traditional foods, perilla leaf has been demonstrated to be of benefit in allergic, respiratory, and digestive ailments (Asif 2012). In a randomized controlled trial, 50 participants with gastrointestinal discomfort and reduced bowel movement frequency were treated with ether perilla extract, 150 mg twice daily, or placebo for four weeks. All gastrointestinal symptoms, including abdominal discomfort, flatulence, rumbling, fullness, and bloating, improved significantly in the perilla group. For bloating, the positive response in the perilla group was 46% greater than in those receiving placebo (Buchwald-Werner 2014).
Perilla may have several modes of action that contribute to its beneficial effects for digestive symptoms. Preclinical studies indicate perilla stimulates motility of the intestinal tract (Koezuka 1985) and may relax intestinal muscle spasms (Verspohl 2013). Other studies found perilla extract can inhibit the inflammatory response generally (Chen 2015; Lee, Han 2012; Oh 2011) and specifically in the large intestine in mice (Urushima 2015). In addition to preventing a stress-induced inflammatory response, an essential oil extract of perilla prevented depression-related behaviors in chronically stressed mice (Ji 2014). Another study also noted a reduction in signs of stress-induced depression and a reversal of stress-induced changes in brain metabolism in mice treated with perilla essential oil. In this study, perilla extract compared favorably to fluoxetine (Prozac) (Yi 2013). Stress, anxiety, and depression are known to be associated with changes in pain sensitivity, gastrointestinal motility, and intestinal permeability via a complex network that connects the gastrointestinal tract, brain, immune system, and microbiota (Moloney 2016). Thus, available evidence suggests perilla extract may be an especially promising treatment option for individuals with IBS.
In one large non-placebo controlled trial, consumption of 72 or 144 mg Curcuma longa extract daily for 8 weeks significantly reduced IBS prevalence and improved quality of life (Bundy 2004a).
The probiotic yeast Saccharomyces boulardii was shown in one study to improve quality of life measures among subjects with IBS after 4 weeks of treatment (Choi 2011).
Stress-modifying natural therapies
Several natural compounds, including adaptogenic herbs (eg, Rhodiola, Bacopa, Holy Basil, Ashwagandha and Cordyceps) and stress-response-modifying nutrients such as phosphatidylserine,may benefit IBS sufferers by mitigating stress.
For example, Rhodiola rosea is effective in alleviating a variety of psychological conditions, including irritability, anxiety, and loss of zest for life (Edwards 2012). As such, it might offer relief to IBS sufferers, although this has yet to be empirically tested. Similarly, some IBS patients exhibited altered dynamics of the stress hormone cortisol (Suarez-Hitz 2012), which may be corrected by an omega-3 fatty acid-enriched phosphatidylserine supplement (Hellhammer 2012; Starks 2008; Noreen 2010).
Research on Bacopa monnieri indicates that it has adaptogenic effects and can significantly decrease stress-related anxiety (Tubaki 2012; Singh 1980). Bacopa (in combination with another herb) was found to be particularly beneficial in IBS-D in a 6 week randomized, controlled trial (Yadav 1989).
More stress-reduction strategies are discussed in Life Extension’s Stress Management protocol.