Dietary changes that may be
helpful: Several studies report that food
sensitivities occur in only a small percentage of people with IBS.1 2
3 Research outcomes are much less clear regarding what percentage of IBS
sufferers are truly sensitive to foods. However, some studies find that most IBS sufferers
have food sensitivities and that gas production and IBS symptoms diminish when these foods
are discovered and avoided.4 5 6 7
According to a leading researcher in the field, at least 3.5 ounces of the offending food
are frequently needed to provoke symptoms of IBS.8 Others have reported that
the offending foods need to be eaten at each meal for at least two days to evaluate the
potential of food sensitivity.9 The amount of test food used in studies
reporting food sensitivity in only a small proportion of IBS sufferers was less than 3.5
ounces. The inadequate quantities of food may have affected the outcome of these studies.
Preliminary evidence suggests that some people with
IBS malabsorb the sugars lactose (as found in milk), fructose (as found in high
concentration in fruit juice and dried fruit), and sorbitol (as found in some dietetic
candy).10 Lactose is frequently malabsorbed, and fructose and sorbitol absorb
more slowly and less completely than regular table sugar, even in healthy people. As a
result, most people in the study, including those who were healthy, showed evidence of
malabsorption of at least one of these sugars. However, unlike healthy people, those with
IBS-like symptoms had greater symptoms when consuming high concentrations of lactose or
the combination of fructose and sorbitol. In this report, restricting intake of these
sugars led to reduction in symptoms in 40% of those people with IBS-like symptoms.
Therefore, when attempting to uncover food sensitivities, people with IBS should consider
the possibility that milk, fruit juice, and dried fruit might cause problems.
Researchers have found that standard blood tests
used to evaluate allergies do not help uncover food sensitivities associated with IBS,
because IBS food sensitivities are not true allergies.11 12 The only
practical way to evaluate which foods might trigger IBS symptoms is to avoid the foods and
then reintroduce them. Such a procedure requires the guidance of a nutritionally oriented
doctor. Attempts to find and avoid offending foods without professional help may well fail
to find the offending foods or exacerbate symptoms.
Limited research has suggested that fiber might help
people with IBS.13 14 However, most studies find that IBS sufferers
do not benefit by adding wheat bran to their diets.15 16 17
18 In fact, some people with IBS actually feel worse as a result of wheat
bran supplementation.19 It has been suggested that the lack of positive
response to wheat bran may result from a wheat sensitivity,20 which is one of
the most common triggers for food sensitivity in people with IBS.21 Rye, brown
rice, oatmeal, barley vegetables, and psyllium husk are good sources of fiber and less likely to
trigger food sensitivities than is wheat bran. However, except for psyllium (see below),
little is known about the effects of these other fibers in people with IBS.
Lifestyle changes that may
be helpful: IBS sufferers have increased rectal pain sensitivity linked to
psychological factors.22 Stress is known to increase symptoms of IBS.23
Reducing stress or practicing stress management skills have been reported to be
beneficial. In one trial, psychotherapy and relaxation combined with conventional
treatment were more effective than conventional treatment alone in two thirds of people
with IBS.24 Hypnosis for relaxation has dramatically relieved symptoms of IBS
in some people.25 26 27
Nutritional supplements
that may be helpful: In one trial, young women with IBS who
experienced worsening symptoms before and during their menstrual period were helped by
taking enough evening primrose oil (EPO) to provide 360–400 mg of
gamma linolenic acid (GLA) per day.28 In that trial more than half reported
improvement with EPO, but none was helped in the placebo group. The effects of EPO in
other groups of IBS sufferers has not been explored.
Double blind research has shown that avoidance of
lactose in people with IBS who are also lactose intolerant will relieve IBS symptoms.29
Alternatively, lactase enzyme may be used prior to consuming milk.
Are there any side effects
or interactions? Refer to the individual supplement for information about any
side effects or interactions.
| Herbs that may
be helpful: Enteric-coated peppermint oil has relieved symptoms of
IBS in double blind research.30 In one double blind trial, four out of every
five IBS sufferers studied experienced reduced symptoms when given enteric-coated
peppermint oil.31 In another of the double blind trials reporting significant
improvement, three to six capsules providing 0.2 ml of peppermint oil per pill were taken
per day.32 The combination of 90 mg of peppermint oil plus 50 mg of caraway oil
in enteric-coated capsules taken three times per day led to significant reduction in IBS
symptoms in yet another controlled trial.33 The combination of peppermint, caraway seeds, and two other carminitive (gas
relieving) herbs, fennel seeds and wormwood, was reported to be an effective
treatment for upper abdominal complaints, including IBS, according to another double blind
study.34 Enteric coating appears
to protect peppermint oil while it is passing through the acid
environment of the stomach. In the intestinal tract, peppermint oil reduces gas
production, eases intestinal cramping, and soothes irritation. In preliminary research, peppermint oil has also reduced spasms of intestinal
musculature.35 Caraway oil is believed to have similar effects to peppermint
oil. A few studies have not found peppermint oil to be helpful.
However, the negative trials are either very short (two weeks)36 or, in one
case where peppermint oil increased symptoms, did not administer the oil by
mouth.37 Besides the use of enteric-coated capsules, herbalists sometimes
suggest that peppermint may also be taken as a tincture (2–3 ml
three times daily) or even as pure essential oil in liquid form (1–2 drops with
symptoms up to three to four times per day). Pure food grade essential oil of peppermint is extremely strong and
must never be consumed except in 1–2 drop amounts. |
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