IBS—or Irritable Bowel Syndrome is a functional digestive disorder that affects the large intestine – the bowels. The most common symptoms are abdominal pain, cramping or bloating, excess gas and diarrhea, constipation or alternating episodes of these conditions. Mucus is often passed along with the stool. Usually, these symptoms are relieved when the person has a bowel movement. The term “functional” means that there are no known underlying anatomic or physiologic conditions that cause IBS.
It is not clear what causes IBS though it is linked to abnormal or disrupted patterns of gut bacteria (such as SIBO) and disordered patterns of muscle contractions in the bowel. IBS is also characterized by inflammation and a lack of effective communication between the nerves of the gut (sometimes called the “second brain”). It can be triggered by stress, certain foods and by hormonal changes in women. It occurs in twice as many women as men and, depending on where you live, can exist in 4-10% of the population. In children and adolescents, the incidence can reach 17%.
IBS can be difficult to treat—and the treatment usually centers on dietary changes, increasing the amount of fiber in the diet and often medications to control diarrhea, constipation and excess gas. These medications can cause side effects and commonly “overtreat”—in other words, when treating diarrhea associated with IBS, constipation results and when treating constipation, diarrhea is often a side effect.
Botanical medicine can offer safe and effective alternatives to medications. In addition to dietary changes, adding specific herbs to a daily regimen can make a significant difference—especially when combined with stress-management techniques, probiotics, prebiotics (to support the bacteria in the gut) and sometimes other modalities such as acupuncture, exercise, and biofeedback techniques.
Evidence-Based Herbal Medicines for IBS
The research is catching up with the traditional herbal approaches, allowing us to provide scientifically based evidence to build on traditional herbal medicines. A recent review suggested that several different natural herbal supplements could provide safe and effective symptom relief.
Aloe Vera Gel
Aloe vera is a succulent indigenous to Africa and the Arabian Peninsula. It has various uses—the gel can be used to treat sunburn and minor wounds and can help relieve heartburn and Gastroesophageal reflux disease (GERD) It is a natural laxative and is used primarily to relieve the pain and discomfort of constipation-predominant IBS. It can also reduce gas.
Turmeric has a long history of use for digestive issues in both Ayurvedic and Traditional Chinese Medicine traditions for digestive issues, abdominal bloating, gas, and pain. It is the orange root that gives curries the distinctive yellow-orange color. Turmeric contains curcuminoids—the primary curcuminoid is curcumin.
Curcumin has potent anti-inflammatory properties, primarily by inhibition of the COX-2 enzyme that is involved in the synthesis of pro-inflammatory prostaglandins. Curcumin also inhibits a pro-inflammatory gene transcription factor NF-κB. It can also act as an antispasmodic, increasing bowel motility.
Hypericum perforatum/St John’s wort
Hypericum perforatum or St John’s wort has been used for centuries as a nervine—in more modern terms, as an antidepressant. It acts by modulating the effects of serotonin, dopamine, and norepinephrine, essentially acting as a natural SSRI.
It also has anti-inflammatory actions. While there is still controversy regarding the specific actions of St John’s wort in IBS, some studies have indicated that the benefit of St John’s wort may be in moderating stress and thus having an indirect rather than a direct effect on the symptoms of IBS.
Mentha piperita/Peppermint Oil
Probably the best known and arguably the most successful herbal treatment of IBS is with peppermint oil. Peppermint oil has been shown to be a safe and effective treatment for IBS in both adults and children. The main active ingredient is menthol which has anti-inflammatory, antispasmodic and antibacterial effects.
In addition, peppermint oil improves motility in the gut and decreases the abdominal discomfort associated with IBS. A meta-analysis of 12 trials representing almost 850 patients was recently published. The authors of this large study concluded that peppermint oil “was shown to be a safe and effective therapy for pain and global symptoms in adults with IBS.”
Ulmus fulva/Slippery elm
Slippery elm is a Native American traditional medicine. It is believed that the mucilages—thick and slippery substances—allow for a more comfortable passage of stool. Preliminary clinical evidence that the inner bark of slippery elm may reduce pain and discomfort, gas, and bloating in both constipation-predominant and diarrhea-predominant IBS.
Psyllium is a well-known source of fiber and has been used successfully to treat constipation-predominant IBS, though it is important to note that psyllium does not appear to reduce abdominal pain or discomfort.
The human endocannabinoid system is well-known to function in the digestive system. Cannabinoids derived from hemp have been proposed as promising agents to reduce intestinal inflammation and abdominal pain. Lab studies have indicated that both cannabidiol (CBD) and cannabigerol (CBG) are effective in reducing inflammation in intestinal cells. Research has been limited, but one trial indicated that in patients with diarrhea-prominent or alternating IBS, a synthetic cannabinoid, dronabinol, was effective in decreasing the frequency of bowel movements.
Commercial Herbal Formulations
In addition to the single compound, isolated formulations listed above, there are several formulations that have been tested in IBS. These include:
- Iberogast (STW 5) and STW5-II
- Iberogast® (STW 5) contains Iberis (bitter candytuft), angelica root, chamomile, caraway, milk thistle, lemon balm, peppermint, celandine and licorice and has been recommended in Europe for the treatment of IBS. Iberogast (PDF) has been shown to improve symptoms of both functional dyspepsia and IBS. It is not clear which herb(s) are most effective, however.
- STW5-II contains iberis, Melissa, licorice, chamomile, peppermint and caraway, and clinical trials have shown significant improvement in IBS symptoms and abdominal pain.
- Traditional Chinese Medicine (TCM) formulations
- A recent meta-analysis indicated that TCM formulations such as Tong-xie-ning (TXNG) and Tong-Xie-Yao-Fang (TXYF) show significant benefits over pharmaceuticals in the treatment of constipation-predominant IBS.
IBS impacts millions per year and can often seem like an escapist’s diagnosis. Have digestive trouble—must be IBS. Sound familiar? IBS is no laughing matter and has become a widespread condition with little indication of a cure in the pipeline. While others may be twiddling their thumbs for an FDA-approved treatment option, research is piecing together a powerful argument for herbal interventions such as those listed above. As with all things health—the magic is in the personal touch and context. Speak with your doctor before considering any of the above treatment options to understand how they may impact you as an individual.