Suffering from IBS and curious about different treatment options? Which IBS treatment is right for you?
In Part 1 of this series, I talked about how IBS (aka Irritable Bowel Syndrome) is a gastrointestinal disorder characterized by abdominal pain and changes with a person’s bowel movements in the ABSENCE of any detectable abnormality of the colon structure or biochemistry. In other words. . . normal scope, normal labs despite symptoms. This is different than Inflammatory Bowel Disease (aka…IBD) such as Crohn’s and Ulcerative colitis.
The first thing to appreciate is that IBS is due to a deeper issue. Medical conditions that can mimic IBS symptoms include:
- Inflammatory Bowel Disease (Crohn’s and U.C.)
- Collagenous Colitis
- Celiac Disease
- Infections
- Ovarian and Colorectal Cancer
- Endometriosis
- Bowel Obstruction
- Diverticular Disease
- Endocrine Issues such as Diabetes, Thyroid dysfunction
- Medication Side Effects
- Poor gut health…due to stress and poorly balanced nutritional choices.
In Part 2 of this series, I will discuss current treatment options. But first, a quick aside: I do believe that our nutritional choices play a major role in ANY of the healthcare (and cognitive) imbalances that we want to improve. So, yes, our food, beverage, and lifestyle choices, to a greater or lesser degree, do matter. How much they matter does appear to be somewhat individualized from person to person. But healthier choices DO produce a healthier person.
Herbal and Nutritional Therapy Treatments for IBS
Nutritional therapy for IBS is indeed the cornerstone for alternative, complementary, and traditional providers. There are several herbs and supplements that can help IBS. Common herbs / supplements that have been used for IBS include:
- Peppermint oil – possibly eases muscle spasms
- Ginger – reduce nausea and gut inflammation, might strengthen gut lining
- Iberogast (a product composed of nine different herbs – may reduce gas and acid, improve digestion
- And others: Barley, Cardamom, Licorice, Rhubarb, and Tangerine Peel
One caution I want to mention regarding herbs and supplements is to do some simple research before trying, as most things we put into our bodies can have unwanted side effects. Since herbs and supplements are not regulated, it can be difficult to know what those side effects are and how prevalent they occur. For instance, Ginger can interfere with blood-thinning agents. Unfortunately, I can’t tell you how much Ginger is needed or how many people run into an issue with taking Ginger and a blood thinner.
Personally, my preference is that we improve and heal the gut (get our supplements if you will) through our food as opposed to popping a pill. I understand this isn’t always possible, but any raw product will always be superior to a processed one, especially if one core issue is poor gut health.
The goal of nutritional therapy for IBS is to restore gut health and heal the digestive tract by correcting digestive enzymes and acid content ensuring better absorption and minimizing leakage.
IBS Diets
As far as available IBS diets go, there are two that are especially popular: the Traditional IBS Diet and The Fodmap Diet.
Unfortunately, I am not a big fan of ‘diets’ compared to changing our nutritional lifestyle and choices. Diets often have limited success and are not sustainable for the vast majority of us.
Remember, in order to make real, long-term changes to our lifestyle we need to change our thinking first. . . All the more reason I’m excited to have our new, ’in-house’ functional nutritional therapist, Karey, discuss this topic later this week. Karey will be a regular contributor.
Traditional IBS Treatments
Unfortunately, traditional therapy, once other medical conditions are excluded, almost exclusively focuses on alleviating the symptoms of IBS as opposed to fixing the underlying digestive imbalance.
So, what meds are used by traditional providers? Let’s break it down:
IBS – C (Irritable Bowel Syndrome – Constipation)
The first med likely prescribed will be: Polyethylene glycol (aka PEG): Miralax or Glycolax
– PEG brings water into the colon
– max dose 34grams per day
If you fail to improve with PEG, you will likely be prescribed. . .
Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)
Linaclotide and Plecanatide can increase motility as well as decrease bloating and straining.
Like PEG, these meds increase motility and fluid in the intestine. Although they can improve constipation, they typically do not improve the abdominal pain and bloating
Another option is Tegaserod (Zelnorm, Zelmac).
However, although Tegaserod stimulates the release of serotonin and has been shown to increase motility as well as decrease abdominal pain it is typically not used in people over 65 years of age and should NOT be used if you have a history of ischemic bowel / colitis, bowel obstructions or adhesions, or symptomatic gallbladder disease.
IBS – D (Irritable Bowel Syndrome – Diarrhea)
The first line med prescribed for IBS – D by traditional providers will be antidiarrheals like Loperamide (Imodium) and Eluxadoline (Viberzi)
Loperamide (Imodium): decreased stool frequency and consistency but does did not help bloating or abdominal discomfort in the studies.
Eluxadoline (Viberzi): Improvement in stool consistency and decreased abdominal pain.
BUT, can NOT use if: gallbladder / billiard / liver disorders or impairment or heavy alcohol use.
0.3% of the people in studies developed Pancreatitis
Second-line meds will bile acid sequestrates: In other words, these meds will bind bile acids in the intestine and prevent them from getting reabsorbed into the bloodstream.
Common Bile Acid Sequestrates: Cholestyramine, Colestipol, Colesevelam
Of note: 50% of people with functional diarrhea and IBS – D have bile acid malabsorption
Unfortunately, these bile acid sequestrates have some unwanted and common side effects to include bloating, flatulence, abdominal pain, and constipation.
A few other meds that a traditional provider will use may include Ondansetron (Zofran) for nausea. In addition, antispasmodics may be used for IBS-D. These meds are typically used on as “as needed” basis when stressors for symptoms are anticipated to occur.
Lastly, the tricyclic antidepressants are often used in conjunction with other meds. Common tricyclic antidepressants include Amitriptyline, Nortriptyline, and Imipramine. These meds do have pain reduction properties by changing the way our nerves receive pain signals. It is thought they increase serotonin and can improve mood. They can also slow gut motility.
Fecal Microbiota Transplantation, having donor fecal microbiota transplanted into the intestine has also been tried and although there was a three-month improvement in symptoms, at twelve months, the people in the study were back to where they were before the microbiota transplant.
A Final Word on IBS
So that’s a bit about the current treatment options for IBS. Clearly, ensuring that an IBS ‘mimic’ (as listed earlier) isn’t the underlying cause of IBS is very important. Once that has been shown not to be the case, it’s time to get our bodies better balanced through our nutritional and lifestyle choices.
Stay tuned and look for Karey’s post, our ‘in – house’ functional nutritional therapist. It should be up this Thursday.
And remember, today and every day, live your value one choice at a time. The world would not be the same without you in it!
