Interest in use of complementary and alternative medicine (CAM) for IBS continues to grow, even though there is not conclusive scientific research. To be clear, complementary therapies are done in addition to traditional medical treatments; alternative therapies are done instead of medical treatments. CAM therapies can be grouped into several categories, including somatic (acupuncture or massage), mind-body (such as hypnosis or meditation), movement or breathing exercises (such as yoga or tai chi) and herbal/dietary supplements.
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Somatic: Acupuncture and Physical Therapy
Acupuncture has not been shown to be more effective than placebo acupuncture in improving symptoms or quality of life in IBS patients. However, some IBS patients claim that acupuncture relieves pain.
Regarding physical therapy, the Clear Passage Approach is a science-based unique hands-on therapy developed over more than 25 years of study. It’s designed to reduce and eliminate abdominal adhesions, which can underlie IBS, SIBO and chronic abdominal and pelvic pain.
Mind-Body: Psychological Therapies and Hypnosis
Ten different psychological therapies for IBS have been evaluated. Research shows that the following can be helpful: cognitive behavioral therapy, hypnotherapy, multicomponent psychotherapy and dynamic psychotherapy.
Hypnosis has been shown to be an effective treatment for IBS in several clinical studies. Olafur S. Palsson, Psy.D., Professor of Medicine, University of North Carolina at Chapel Hill, has standardized an IBS hypnosis treatment protocol.
Meditation and Yoga
No studies on IBS have been conducted for meditation and specific movement treatments, such as tai chi and yoga. However, eliciting the relaxation response through these techniques reduces the stress response, which benefits overall health.
Herbal and botanical supplements have been used to treat a variety of ailments for centuries. While many products are available without requiring a prescription, clear efficacy, safety and drug-interaction information is sparse. Research evaluating Chinese herbal remedies for IBS has shown mixed results. Major problems with herbal products in general are multiple ingredients, lack of clarity regarding active ingredients and lack of standardization.
If taking herbal or botanical supplements is considered, patients should inform their doctor. Like drugs, they have chemical and biological activity and could cause side effects or interact adversely with certain medications. Here are examples of over-the-counter products that can be helpful and used in combination:
1) Beano is the brand name of a supplement containing natural enzymes that can break down the complex carbohydrates found in many foods, such as beans, vegetables and whole grains.
2) Alpha amylase-containing products augment the function of the gut enzymes that break down carbohydrates (glucosidases).
3) Iberogast was developed in Germany more than 50 years ago and contains nine Western-based herbs.
4) Lactase is the enzyme that breaks down lactose carbohydrate in dairy products. Lactase-containing dairy products and enzyme supplements are also available (such as the drink, Lactaid).
5) Peppermint oil has been used as a digestive aid for centuries, with antispasmodic, analgesic and antimicrobial effects. While multiple formulations of peppermint oil are available, IBGard is the brand name of a peppermint oil dietary supplement backed by scientific research for management of IBS.
6) Probiotics are dietary supplements containing live microorganisms that, when ingested, may exert a beneficial effect on the host. Probiotics are generally safe and well tolerated. Probiotics are thought to exert their influence on the intestinal microbiota by a number of mechanisms, including stabilizing motility, improving barrier defense (leaky gut), antibacterial and/or antifungal effects, preventing the adherence of pathogens to the gut lining, immune regulation, anti-inflammatory effects and more.
The increasing number of probiotic products available range in quality from those that have been tested and scientifically validated to those that have unsubstantiated claims of health benefits. If probiotics are used, it is recommended that a given product be taken for at least four weeks at the manufacturer’s recommended doses while assessing therapeutic benefit and unwanted side effects.
Several probiotics have been studied and are commonly used. Lactobacillus is a common constituent of many commercially available preparations, including lactobacillus GG in Culturelle. Bifididobacterium is also a common constituent of many products. Bifidobacterium infantis 35624 is a specific strain (found in the product Align). Bifidobacterium lactis is found in many products, and one brand is the exclusive probiotic culture Bifidus Regularis, or Bifidobacterium lactis DN-173 010, found in Activia yogurt.
Many multistrain probiotics are commercially available, including VSL#3. Saccharomyces boulardii is a yeast. One brand is Florastor.
Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is commonly associated with IBS. There is increasing interest in, and some evidence for, treating SIBO with herbal supplements. Allison Siebecker, N.D., maintains a very informative website regarding the diagnosis and treatment of SIBO.