What really works for the treatment of Irritable Bowel Syndrome
We have all been through the launch of expensive medications like Zelnorm for Irritable bowel syndrome only to then see them pulled from the market, making all of us skeptical that anything works. Most patients with irritable bowel syndrome are managed by primary care doctors and there is an ongoing search for effective treatments that are safe, inexpensive and readily available. So, what works? This question was asked and answered in a recent systematic review of the literature published in the December 13, 2008 British Medical Journal. When other causes for your abdominal pain, diarrhea and/or constipation are ruled out and you receive a diagnosis of IBS you want to know what remedies really work.
Fiber: Twelve studies using fiber for treatment of the irritable bowel symptoms were reviewed and found fiber to be effective. Symptoms were relieved in those taking fiber as compared to placebo or no treatment. Importantly, the benefit was limited to studies of ispaghula (psyllium). Psyllium (Fiberall, Metamucil) is easily available as a powder you can add to your drink. Does it work to improve symptoms? Yes, in the many studies on psyllium persistent symptoms were reported by 52% of patients assigned to psyllium versus 64% of those assigned to placebo.
Antispasmodics: After reviewing 22 trials the investigators found that antispasmodics did reduce symptoms compared to doing nothing or placebo. Of the many different antispasmodics evaluated, those showing consistent efficacy were otilonium (otilonium bromide or OB), and hyoscine (Buscopan).
Peppermint Oil: Perhaps the most surprising findings were that analysis of four trials on peppermint oil found that it was effective for the treatment of IBS. Watch it here because Peppermint oil is known to worsen heartburn symptoms so it does come in enteric coated capsules. Peppermint oil is especially effective in reducing flatulence and abdominal pain and distension. A benefit is seen using peppermint oil for the treatment of IBS symptoms over placebo.
Is there a perfect cocktail for IBS? Discuss this with your doctor but it’s looking like psyllium, antispasmodics (preferably hyoscine), and peppermint oil make sense as first line treatment for the irritable bowel syndrome.
Your experience?
Dr O.
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I read in one of the previous posts about a lady going on gluten-free diet and she felt a lot better. I recently was diagnosed with celiac disease.Just happened i went for a colonoscopy and endoscopy and had to have blood tests which showed higher then normal #s which are consistent with celiac. I went on a gluten free diet right away. I think that a lot of people should ask their doctors about that . See if you can get a blood test for gluten tolerance.. it might be the cause of the IBS for some.
By heartofgoldie March 18, 2009 1:18am
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And stress, doesnt it affect IBS. I find it does affect me or maybe it is in my head? I have IBS that goes both ways on the spectrum. live in a hot climate, sometimes not enough water intake. then certain foods, spices, expresso coffee, turns things in the other direction. big whoopy! I take fiber about a teaspoon everyday, but have cramps and burning in the left abdominal side, colon , when i take more fiber. Also i love salads, but found that can trigger a major bout of diareah! The school cafeteria, along with other places put some stuff on salad to preserve it. major problem for me!!! Well just can't trust the school food now! afraid i won't make it through the day. deeee
By deeee December 27, 2008 9:45pm
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Traditional Chinese Medicine! Acupuncture and herbs has worked for me.
Be sure to go to a well respected, licensed dr., however. Mine is an MD, also.
By Romini December 26, 2008 7:35pm
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Eliminating gluten has not been the magic solution for me. Drinking peppermint green tea helps sometimes, believe me I have tried everything I have heard, read, and invented as a possible trigger. I would feel better if I just didnt' have to put anything in my stomach.
By desrtrse December 22, 2008 8:27pm
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i agree wholeheartedly about removind gluten from the diet, it helps heaps
By janicesf December 22, 2008 6:48pm
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I was diagnosed with IBS many years ago, but following the diet and taking the meds only helped somewhat. It wasn't until, FINALLY, I was diagnosed with Celiace Diseast, that the biggest problem could be dealt with - GLUTEN!!!
Try eliminating gluten from your diet (it's pretty tricky) and see if things improve a lot. It's worth it! Or, even better, talk to your doc about it.
By Unsinkable December 21, 2008 5:34pm
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After reading some of the other comments, just wanted to mention that probiotics did nothing for me, I have eliminated dairy, wheat, soy, and many other so called solutions. I may get relief for a minute but my body adjusts and continues to react with bloating and constipation. I am fighting a loosing battle here and most days I just wish I didnt' have to eat at all. What I know is that my body is shutting down and resists everything. Ihave no metabolism despite my attempts to stimulate it with exercise, good foods.etc. I often feel if I could just get my metabolism back up and running, my thyroid functioning normally, and my adrenals healthy, I would not be suffering so much with my stomach. But I have not yet found the solution and believe me I am trying everything I can find to correct these problems. I do not eat processed foods or fast foods, everything is live, organic, and natural. I do however have some problems with sugar that I constantly crave and try to avoid but not always successful, this includes fruits and the dreaded chocolate attacks. It seems that will power is not enough in this addiction, I work on it everyday and fail often, that is why I just wish I didn't have to eat at all, I do better that way but then that shuts down metabolism so it is a loosing battle for me everyday.
By desrtrse December 21, 2008 1:02pm
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Fiber? are you kidding, fiber only adds to the bloating which can be the worse symptom for me daily, all day everyday. Ever know what it is like to have a balloon for a stomach and it gets inflated to the point of pain and difficult breathing? I have to stay away from fiber as much as possible. Trying to find a diet that is comfortable is an ongoing challange. Zelnorm was the best relief medicine but alas it is gone. I now take amitiza and use peppermint, anise, and a few other things in my attempts to get relief. Sometimes they work, mostly it is an ongoing miserable battle. I now have a weight problem and look 6 mos pregnant all the time. I don't eat too much, probably too little but still I am obese and miserable. My IBS with constipation is the worst thing that has happened to me in my battle with fibromyalgia and there is no real relief.
By desrtrse December 21, 2008 12:52pm
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I have several friends in their 50's who have suffered for years with IBS and have found amazing relief through an all organic juice. you will have to email me to for more information. principecia@telus.net Have a wonderful day.
By Sharon007 December 21, 2008 12:33pm
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I used to be on this or that prescription for my IBS, and none of them were effective, and only made me feel more bloated and uncomfortable. I had done a lot of reading online, in magazines,etc., and I had heard that taking a Probiotic would help. Guess what?? It works perfectly. The brand I use can be bought in the supermarket even.
By flip12flop December 19, 2008 10:01pm
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I just want to emphasize to actually be evaluated for other conditions and not just "think" it is IBS. I thought for years that I had IBS. I had a lot of the same symptoms. Turns out I had diverticular disease. So don't try to self medicate. Diverticualar disease can be very serious, and sometimes the symptoms are alot alike.
By gramy December 19, 2008 5:12pm
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Going on a gluten-free, dairy free, egg free diet - going regularly, not bloated, lost 30 pounds - yahoo! Also take probiotics daily. Have increased water intake.
By featherme65 December 19, 2008 2:48pm
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I have had IBS for 36yrs. I will not go into the hell I lived with. One day at the dr's he said he saw an article and thought it may help me. It is call "DICETEL". IT WORKS! I have been on it for years and have had very few episodes. I take 3 tablets a day. It changed my life!
By susant14 December 19, 2008 12:41pm
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Hey you guys
Search through my previous blogs (click on view all articles by Dr Orrange) where I discuss probiotics....
Dr O.
By DrOrrange December 19, 2008 12:01pm
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Thank you for your update. What probiotic works best in the intestine?
Alice krieger
al67
By al67 December 18, 2008 9:34pm
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I was having IBS Symptoms, and unfortunately my old Family Doc never picked up on it...my main symptom was bloating, but also had diarrhea and constipation at times.
It wasn't until I finally got my PTSD diagnosis, and 3 Pdoc's later that someone addressed my IBS issues, as it most likely stems from my PTSD.
My Pdoc prescribed me Librax, a combo of an older Benzodiazepine and anti-spasmodic --chlordiazepoxide/clidinium-- This has really helped my IBS symptoms! It works for me! :)
By TLCDaisy December 18, 2008 2:25pm
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Hear Ye, Hear Ye---I am doing very well since adding fiber to my diet and I have been drinking peppermint tea since my acupuncturist recommended it over a year and a half ago.
And I only get heartburn rarely since avoiding those foods that trigger it.
By marymargaret December 18, 2008 1:39pm
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For many, insloluble fiber is too harsh irritable to the bowels with those with IBS and digestive problems. It is something that cannot be digested and is sort of like taking sawdust to give you some roughage to scour the system. Many systems do not respond well initially to that approach such as psyllium and other insoluble fibers scouring the system in rough way.
An approach initially is to take insoluble fiber and soluble fiber blend. One can get cyclical diarrhea and constipation with only insoluble fiber due to the irritation to the bowel with the roughage. Starting with a larger % of insoluble fiber which acts like a gentle push of the food through the system without irritation with a little insoluble fiber. Over time, if possible you can titrate a more higher % of more insoluble fiber to soluble fiber ratio. Both have different functions and each system will respond to certain approaches. Prima Yerba is a great product which combines both soluble and insoluble fiber, but higher on soluble fiber and gently gets things going in the right direction gently. With many of these approaches there are about 50% of the population where the products do not help.
Prima Yerba and enteric coated pepermint oil with real organic pepermint tea( anti spasotic properties and fennel( reduces bloating) really help and made with a frech press and hot water to make large amount of tea. Arcacia powder is an organic tasteless all soluble fiber product and is a totally soluable fiber natural product which could be used exclusively as a supplement to give only insoluble fiber initially, then graduate to Prima Yerba mixture in capsules or powder. this approach can possible help the other 50% or more that the products mentioned do not work and cause and increase in painful intestinal problems.
Starting with this approach first will cause no problems and needs to be adhered to for a while before working well. It never causes problems and only could help. all of these products can be either purchased in totally organic form in good health food stores and http://www.helpforibs.com/ is a great website with this approach and works with all natural and organic products.
As far as an antispasmotic goes, bizmuth chloride with is the active ingredient in pepto bismol function is to reduce the spasms in the intestine espeically during diarrhea episodes and is an otc and has been around for years reducing spasmotic peristalsis which is the wave like motion in the intesting to drive waste to the large bowel and colon. So if you have diarrhea and take and antidiarrheal( I call a chemical cork) then you can have rebound constipation and create a vicious cycle. Bizmuth choride is very gentle and can reduce the spasms of your intestines and colon enough to create a gentle reduction in spasms that cause IBS like symptoms to be reduced in a painful acute problem.
The problem with some products from health food stores tht stimulate the colon to increase peristalsis, it can trigger a cyclical prolems just like medical stimulants to increase digestive action. This can be problematic if the colon is already in a dysfunctional spasmotic action causing the slowing of waste through the system and it can get stuck and casue toxins to be realeased into the body due the this waste sitting there in the colon and intestine and act like a toxic sepsis of a sort and cause pain in the body in the joints and other general pain which can cause fibromyalgia and chonic fatique symtoms for may as these toxins cause swelling and irritation in the body which can manifest itself ans bloating, swollen joints, general malaise, etc.
Lastly probiotics are exremely important to crowd out the bad bacteria that develops due to this toxic waste that can stay in the intestine and colon for long periods of time. This product can keep a good level of good bacteria to crowd out the bad bacteria and its toxins. It is a numbers game. The more good bacteria overwhelm the bad bacteria and create a more normal healthy environment for the colon to be in a non-toxic healthy state. Jarodophillus is a high quality organic product that is enteric coated that has a large number of several strains of the good bacteria probiotics and does not need to be refrigerated. The advantage of multiple strains of cultures of bacteria is that some systems have a deficit of one of these organisms or another. Ultimate flora by renew life has the largest numbers of cultures in the greatest amounts, but needs to be refrigerated.
So,as a summary:
-a high blend of soluble fiber and slowly adding insoluble fiber( read the labels) like organic arcasia tasteless powder and graduating to organic Prima Yerba with a combo of insoluble and soluable fiber.
-peppermint and fenel organic tea made fresh with a french press calms the intestine and reduces spasms. It tastes really good too. Enteric coated pepermint oil reaches the large instestine and colon without being destroyed by the acidic stomach.
-high quality enteric coated probitiotic to work on the intestines and colon to create the proper amount of good bacteria to reduce toxins from bad bacteria
pepto bismol( bizmuth chloride can alleviate spasmotic as an otc remedy
herbal formulas that relax the colon and intestines and stay away from herbal products that increase spasms as stimulus to peristalis.
Consult your doctor always. Most will be open to this organic and whole food approach and can help you supplement this this medication if necessary for spasms of the colon. This is a different approach in the fact that you try to reduce the spasms and start with soluble fiber first as opposed to starting with insloluble fiber which is suggest always as the first approach. It can be blended in later in your cocktail of helpful products by your doctor's help. The doctor must have a good working knowledge in this area and be open to logical alternative treatment regimens.
Good luck,
chris reynolds writespect@aol.com
By cjrvision December 18, 2008 11:27am
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Many years ago I was in a very stressful job as a HR manager and suffered terrible IBS. I left the job in 1990 to start my own business. The IBS was gone in 2 weeks and has never come back in 18 years. Of course, running a small business is stressful, but I think it is a different kind of stress. I believe that stress is over looked in IBS, especially in women.
Nancy
By NancySC December 18, 2008 11:09am
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If you have mercury toxicity, you may never resolve your IBS (although you may try to control it with diet, etc.) I suffered for years and stuck to a severely restricted no grain no sugar diet (if I strayed from it I got sick). My problems were finally resolved for good when I got my last two mercury amalgam fillings out (fibromyalgia and a host of other symptoms also went away after mercury chelation). You may want to look into this if you have chronic IBS especially if you have numerous other symptoms such as fibromyalgia, chronic fatigue, memory/concentration problems, depression, allergies, and autoimmune problems. Things that were helpful to me, before detoxifying mercury, were the candida diet, natural antifungals (raw garlic, goldenseal) and plenty of probiotics. There is a very good chance that you do not have enough beneficial good bacteria (especially if you have had antibiotics) and therefore, would benefit from probiotic supplements and foods (sauerkraut, kimchee, etc.). Aloe vera juice is good as well.
By SparkyKC December 18, 2008 10:15am