Natural treatments for Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a condition which has symptoms of abdominal pain and cramping, diarrhoea and/or constipation, nausea, flatulence and bloating. IBS can affect many people and finding the most effective treatment is individual to symptoms experienced. Herbal medicine, nutritional supplements and alternative therapies may offer relief of symptoms.

Classifying Irritable bowel syndrome

Symptoms of IBS can be classified as:

• IBS-D - which predominates diarrhoea 
• IBS-C - which predominates constipation 
• IBS-A - an irregular bowel pattern that alternates from constipation to diarrhoea 

A symptom diary over a four-week period can help with classification.

Diagnosing Irritable bowel syndrome

The essential and often-ignored step in dealing with IBS is to ensure a definitive diagnosis through a medical practitioner. Symptoms of IBS can be early signs of more serious conditions such as Inflammatory Bowel Disease (IBD) or Coeliac disease. Blood or mucus in the stool (bowel motion) and severe pain should be referred to a medical practitioner immediately.

Five key habits targeting symptoms

Beneficial habits include increasing soluble fibre, water intake and exercise, reducing stress and anxiety and identifying possible triggers. Treatment considerations should focus on the predominant classification (diarrhoea, constipation or mixed) of IBS.

Increase Dietary Fibre

Best for: IBS-C Fibre helps to relieve constipation. Increasing fibre in the diet can be achieved by gradually eating more foods that are high in soluble fibre. Increase fibre intake slowly and boost water consumption.   Soluble fibre softens the stool making bowel motion to pass more easier. 

• Key sources of soluble fibre include oats, lentils, flaxseeds, apples, berries, cucumbers, carrots, celery, oranges and pears.

Increase water consumption

Hydration improves fluidity. IBS-D sufferers are at risk of dehydration due to diarrhoea. Mild dehydration can exacerbated IBS symptoms, and cause other issues such as headaches, mood swings, depression and irritability. For IBS-C, adequate water intake can help prevent constipation. How much water is enough? It's easy: 1 litre of water for every 25kg of body weight, per day. [Your body weight in kg] / 25 = how much litres you need per day! Don't wait till you are thirsty, thirst is an indicator of  dehydration. 

Exercise

Thirty minutes of moderate-intensity aerobic exercise has been shown to be an effective treatment for IBS. This is because exercise improves muscle tone and helps with bowel movement. Exercise also reduces stress and anxiety.  

Support for Stress

Symptoms of IBS can be a cause of emotional stress, and stress can also exacerbate symptoms of IBS! 

Employing tools for stress support through the inevitable ups and downs of life can reduce the frequency and severity of IBS flare-ups.

Relaxation techniques, meditation, yoga, massage, journaling, acupuncture or deep breathing exercises. Support from a therapist or psychologist can be beneficial for unresolving stress. 

Identify & eliminate common triggers

A “reverse food diary” can help identify triggers. Record symptoms when they are experience - foods eaten over the previous 3 days prior to symptoms. This can help identify key foods to avoid or reduce. 

For more constant IBS symptoms a detailed food and symptom diary for a week or more on foods eaten and the symptoms experience. Food sensitivity and allergy test can often assist with identify food causes of IBS.

Common triggers of IBS

• Caffeine. Found in coffee, tea, green tea, macha, cocoa, chocolate, cacao and some medications.
• Soft drinks. Including diet and energy drinks, and some sports drinks.
• Refined sugar. Found almost everywhere! Tolerance to refined sugar is different for every individual.
• Alcohol
• Gluten. While celiac disease or gluten allergy is often misdiagnosed as IBS, gluten intolerance is a common trigger for IBS. Test for celiac disease before cutting gluten out of the diet for the test to be successfully performed a regular diet of gluten has had to be consumed.
• Dairy. ​​Some dairy product can cause symptoms whilst other are ok for some people. Yogurt and butter are often better tolerated than milk and cheese for example. Different probiotic strains in yoghurt and fermented foods may also be responsible. 
• FODMAPs. FODMAP intolerance has been associated with IBS.  FODMAP intolerance occurs when the gastrointestinal tract fails to digest or absorb particular types of molecules found in foods. FODMAP stands for (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). FODMAPs are found in many foods - elimination should be performed under the guidance of a professional. 

Herbal and nutritional therapies

Psyllium Husks

Best for: IBS-D or IBS-A Psyllium husks are a highly absorbent form of fibre made from the seeds of the Plantago ovata plant. When combined with water, psyllium husk forms a mucilaginous substance which acts as a gentle fibre.

As a functional food, psyllium is a source of soluble fibre that adds bulk to the stool, thereby reducing symptoms of diarrhoea in IBS-D and IBS-A patients. 

As an added benefit, the process of colonic fermentation of soluble fibre produces a by-product called butyrate. This is an important short-chain fatty acid that has also been shown to reduce IBS symptoms of bloating and pain.

Slippery Elm

The slippery elm tree (Ulmus rubra) is native to North America. Medicinally, its powdered bark is used as a demulcent for mucous membranes. In IBS, it has a soothing effect on the walls of the gastrointestinal tract. The astringent qualities of slippery elm help tighten epithelial barriers of the digestive tract, promoting repair of leaky gut, and preventing infections. Like psyllium husks, slippery elm is mucilaginous and adds bulk to the stool, helping to relieve diarrhoea.  

Probiotics

Imbalances of different strains of gut bacteria is often implicated in gastrointestinal symptoms, and many other conditions. 

The microbiome balance is about the number of “good guys” (the types of bacteria who keep our intestines healthy and happy) versus “bad guys” (or pathogenic bacteria, the types who cause inflammation and promote symptoms). 

Taking probiotics can boost the numbers of the “good guys” in order to re-balance the microbiome.

Strains of probiotic bacteria treat different conditions. For most people, a broad-spectrum probiotic can be beneficial in relieving many of the symptoms of IBS. A 2016 meta-analysis showed that the greatest improvement in symptoms occurred in studies that used single strains of bacteria to treat IBS. In particular, Saccharomyces cerevisiae holds promise in relieving symptoms of IBS-C , and Sacchromyces boulardii may be beneficial in IBS-D. It  can take 1 – 3 months of probiotic therapy to re-balance the microbiome of the gut. Reduce stress, caffeine, alcohol, refined sugar, saturated and trans fats for best results. 

Peppermint Oil

Best for: IBS-D or IBS-A Peppermint oil has been used for centuries in the relief of gastrointestinal upsets due to its antispasmodic actions. Traditionally the oil would be applied topically on the skin of the abdomen, or brewed in peppermint tea (both are still excellent, gentle remedies!). Now, enteric-coated capsules can deliver the peppermint oil directly to the intestines where it can deliver a more targeted antispasmodic effect to reduce cramping and diarrhoea .

Chamomile Tea

German chamomile flower is a popular herb with a strong history of use in the treatment of gastrointestinal issues. Chamomile offers antispasmodic properties which can help relieve cramping and bloating. It has a gentle sedative action promoting sleep. 

References

1. MerckManual(2013)IBS.professional/gastrointestinal_disorders/irritable_bowel_syndrome_ibs/irritable_bowel_syndrome_ibs. https://www.msdmanuals.com/
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9. Spiller, R. et al. (2016) Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation. United European Gastroenterology Journal, 4:3, 353 – 362. https://pubmed.ncbi.nlm.nih.gov/27403301/
10. Abbas, Z. et al. (2014) Cytokine and clinical response to Saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial. European Journal of Gastroenterology and Hepatology, 26:6, 630 – 639. http://www.ncbi.nlm.nih.gov/pubmed/24722560
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