This article originally appeared on Health.com.
Treating irritable bowel syndrome (IBS) can be tough. It’s characterized by abdominal pain and either constipation, diarrhea, or a combination of both, but its symptoms are different for every person who suffers from it. So, then, is what works to provide relief.
Medications are available to ease the symptoms of IBS, but some patients feel better trying natural remedies instead of (or in addition to) conventional drugs. The problem is, says Yuri Saito-Loftus, MD, a gastroenterologist at the Mayo Clinic, there’s not nearly as much scientific research on these “treatments” to show how well they really work.
“There’s usually not a big pharmaceutical company with billions of dollars to sponsor a randomized clinical trial for these alternative remedies,” says Dr. Saito-Loftus. “A lot of what we rely on to make recommendations to our patients are the rare cases when either the government or a large supplement company has enough interest to fund a study.”
A new review does provide some hope for people who get no benefit, or have bad side effects, from traditional IBS medicines: Writing in the British Journal of Pharmacology, researchers noted that several alternative therapies do seem to be effective at relieving symptoms.
We asked Dr. Saito-Loftus (whose research is referenced in the review) for her thoughts on these and other natural remedies. Here’s her advice—including some words of caution—about what’s worked for her patients.
These live bacteria—found in supplements or in fermented foods like yogurt and kefir—fared well in the newly published review: The authors noted several randomized clinical trials that suggested probiotic consumption can relieve abdominal pain and other IBS symptoms better than placebo.
But the news isn’t all great. “I’ve met patients who swear that they make all the difference in the world, and others that don’t feel they make much of an impact at all in their symptoms,” says Dr. Saito-Loftus. “One problem is that there are so many brands and formulations, chances are what you pick up in the store is not the same product that performed well in clinical trials.”
Dr. Saito-Loftus is also cautious about recommending probiotics to IBS patients because they do alter the amount and ratio of natural gut bacteria—which, in some cases, could do more harm than good. Her advice? Talk to your doctor about the potential risks and benefits, and decide together whether to give probiotics a try.
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Only a few studies have been done on prebiotics—nondigestable carbohydrates that feed the good bacteria in your gut—with conflicting results, the new review notes. (The same goes for synbiotics, which are combination products that contain both pre- and probiotics.)
There’s not enough evidence to say how well they really relieve IBS symptoms, says Dr. Saito-Loftus. But there’s little harm—besides the price tag of the supplement—if patients want to try them, she adds. Prebiotics are also in healthy foods like garlic, onions, bananas, and raw asparagus, as well, and eating them can be a win-win.
“With prebiotics, patients aren’t consuming live bacteria, so I like that it’s more of an indirect way of trying to manipulate your microflora,” she says. “They’re certainly reasonable to try, but there’s not a lot of background to form conclusions either way.”
Getting more fiber, either through food or supplements, does seem to improve some cases of IBS, says Dr. Saito-Loftus. The new review cites several studies on different types of fiber—including psyllium, wheat bran, and calcium polycarbophil—that had promising results in earlier studies.
“I definitely am a big advocate of at least trying fiber as a remedy, particularly for my patients with constipation-predominant IBS,” says Dr. Saito-Loftus. She’s a bit more cautious for those who have a lot of bloating, gassiness, or diarrhea, since fiber can make these symptoms worse.
Foods high in fiber—such as beans, fruits, vegetables, and whole grains—are typically low-calorie and full of vitamins and other nutrients, so Dr. Saito-Loftus recommends incorporating them into your diet if you can. But if getting all your fiber from food is too difficult, taking a regular supplement can help make up for what’s missing.
“I do caution my patients that fiber doesn’t work for everybody,” she says. “But if you find that after transitioning to a high-fiber diet that you aren’t feeling better, at least you can say you tried.”
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Of all the herbal remedies studied in the new review, peppermint oil seemed to have the most promising results, with clinical trials dating back to 1972.
“It’s something I recommend to patients particularly with a lot of IBS-related pain,” says Dr. Saito-Loftus. “Peppermint oil is thought to be a natural anti-spasmodic, and it seems to be beneficial—maybe not for constipation or diarrhea, but specifically for those who do have a lot of pain.”
Dr. Saito-Loftus also recommends Iberogast (also known as STW-5), a trademarked liquid formula made of nine different plant extracts—including peppermint—to patients with IBS-related pain. It seems to work particularly well for people who have pain around mealtime, she adds.
In the new review, the authors note that Iberogast also seems to have anti-spasmodic qualities, although it’s unknown which ingredient (or ingredients) are most responsible.
These supplements weren’t included in the review, but Dr. Saito-Loftus says that they may be helpful, particularly for people with diarrhea-predominant IBS. “It may simply be that there’s no data on them, but I can tell you that a lot of my patients come to me already taking them,” she says.
Dr. Saito-Loftus says the risk of trying these is low, and the potential benefits—anecdotally, at least—are high. “I’ve had patients who swear by them, and others who have not,” she says. “It comes down to reading the bottle and considering the price and making the decision whether it’s worth it to give them a try.”
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While stress relief may not come in a bottle (and was not discussed in the new review), Dr. Saito-Loftus says it’s one of the most important natural remedies to consider when dealing with IBS.
“I think sometimes stress worsens symptoms and sometimes symptoms worsen stress, but the combination of the two is very important,” she says. “You can’t always modify your stressors, but you can modify your response to that stress—and I think working on that is so important.”
She encourages patients to explore different options for stress reduction and find what works best for them. “For some people it’s yoga, exercise, or meditation,” she says. “And sometimes it’s simply a matter of mindfulness and reflection, and making a conscious effort to try not to worsen the stress that’s already there.”