By Matt Gowan, BSC, ND
July 27, 2017

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Natural Remedies for IBS – The top researched natural supplements for IBS

By Matt Gowan, BSC, ND
July 27, 2017

Irritable bowel syndrome (IBS) is a cluster of symptoms that may include abdominal pain, bloating, diarrhea, and constipation. There are several causes of IBS ranging from food sensitivities, different types of infections (e.g. SIBO) and stress. Determining the cause of IBS can help develop the most effective treatment strategies. Although dietary changes for IBS should be the first-line approach, the following natural remedies for IBS can be used concomitantly.

How can natural remedies for IBS help?

Natural remedies for IBS can work by several different mechanisms.  Many of the remedies have an antispasmodic effect that helps decrease cramping pain and an analgesic effect that relieves general abdominal pain.  The majority of the selected treatments can normalize bowel movements by having both an antidiarrheal effect and also promote peristalsis. The following natural remedies for IBS were selected because they are commonly used by natural health practitioners and are also supported by research.

1) Probiotics – One of the essential natural remedies for IBS

Probiotics are “good bacteria” that reside in our bowels. Because of their excellent safety profile and general health promoting benefits, probiotics are one of the top natural remedies for IBS. Research demonstrates that probiotics, especially multi-strain formulas, are effective for IBS in both children and adults.1 These good bacteria reduce symptoms of abdominal pain, bloating, vomiting, diarrhea, and constipation.2–7 Moreover, probiotics significantly reduces depression and improves quality of life in IBS patients.1,8

GENUS STRAINS
Table 1.
LACTOBACILLUS
L. casei
L. reuteri
L. gasseri
BIFIDOBACTERIUM B. infantis
B. longum
OTHER Saccharomyces cerevisiae
Bacillus coagulans

 

How do probiotics work?

Probiotics possess anti-inflammatory effects: they significantly reduce pro-inflammatory cytokines and TLR-4 and increase IL-10.9 They also reduce the body’s response to food sensitivities by modulating the immune system.10 Also, the probiotics can have a bulking action in the bowels to help relieve constipation.11 Furthermore, probiotics help fight off various infections in the bowels that may contribute to IBS symptoms.

How do I take probiotics?

A low dose of single strain probiotics appears ineffective.  Try taking a multi-strain probiotic with at least 10 billion CFU/day.12

How safe are probiotics?

Only a few adverse events were reported which mostly affects the gastrointestinal or respiratory tract.13

2) Peppermint oil – Relieves IBS pain

The essential oil of peppermint is a well established natural treatment for IBS14,15  Peppermint is classified as a carminative, which is used to relieve cramping, bloating and gas.  A process called steam distillation extracts the essential oils from peppermint producing a highly concentrated liquid that is often encapsulated.   Peppermint oil significantly reduces abdominal pain16,17 and patients report improvements within 24 hrs.18  However, the benefits are only temporary and not curative.18–20 Therefore peppermint oil is one of the best natural remedies for IBS to relieve the acute symptoms but you must still investigate the cause of the IBS and treat it accordingly.

How does Peppermint Oil relieve IBS pain?

Peppermint oil exhibits spasmolytic properties and modulates pain by affecting visceral hypersensitivity.15,21,22  Furthermore, peppermint oil has an antibacterial activity that may help with gastrointestinal infections.23

Peppermint oil - natural remedies for IBS

Peppermint

How do I take peppermint oil?

Although peppermint oil is available as a liquid, encapsulated forms are easier to take and help transport the peppermint oils to the bowels where they can have their greatest effect.

  • Capsule: 180 mg/day

How safe is peppermint oil?

Peppermint oil is very safe when taken as recommended.  Side effects are minor and may include heartburn, headache, and allergic reactions. Peppermint oil is not recommended for pregnant and breastfeeding women due to lack of safety studies.15,20

3) Psyllium – Helps relieve both constipation and diarrhea

Psyllium is a bulk laxative that helps reduce both constipation and diarrhea simultaneously. Research shows psyllium supplementation relieves IBS symptoms including abdominal pain, stool consistency and abdominal distention in adults and children.24–26

Psyllium - - natural remedies for IBS

Psyllium

How does psyllium work?

Psyllium is different than other natural remedies for IBS because of its rich fiber content. It exerts a natural laxative effect through its high-water holding capacity: it bulks up the stools and also prevents dehydration.27 Furthermore; it aids constipation because it stimulates stretch receptors and increases peristalsis.

Psyllium also has anti-diarrheal effects.28 When psyllium fiber absorbs water, it forms a gel thereby increasing the number of normal stools while decreasing liquid stool.29

How do I take psyllium?

Psyllium is available in powder or capsule forms.  Always take psyllium with a large glass of water.

  • Psyllium husk: 10g /day

How safe is psyllium?

Psyllium seed is generally safe however a high proportion of patients experienced diarrhea, constipation, and flatulence, although to a lesser extent compared to placebo. Other adverse events include backaches, lower urinary tract infections, muscle or joint pain, fatigue and headache.25

Caution: Psyllium must be taken with lots of water to avoid choking.30

4) Berberine – Both an antimicrobial and antidiarrheal agent

Several different berberine containing herbs have been used as natural remedies for IBS by herbalists.  Berberine is a component found in various herbs including Goldenseal, Barberry, Oregon Grape and Chinese Coptis. These herbs have been used historically as natural antibiotics. Berberine is a broad-spectrum antimicrobial agent that targets pathogenic bacteria, yeast, and parasites, all of which are causes of IBS.

In addition, berberine containing herbs have been used to improve digestive function and gastrointestinal symptoms.31,32 Berberine possess antidiarrheal properties.31  In humans with IBS, berberine supplementation reduces diarrhea, abdominal pain frequency and the urgent need to defecate.32 Berberine also reduces depression, anxiety, and improves quality of life in IBS patients.

Goldenseal - natural remedies for IBS

Goldenseal

How does berberine work as a natural remedy for IBS?

Berberine is similar in structure as opiates. Although berberine is not as potent, or addictive, like opiates, it does bind opioid receptors (deltoid- & mu-opioid receptors)33,34 thus slowing down GI transit and reducing visceral pain. Furthermore, unlike opiates that have a strong suppressive effect on the bowel movements and cause constipation, berberine modulates peristalsis thus both stimulating and reducing gut motility simultaneously.35 Therefore berberine has a normalizing effect on and may be useful for IBS with alternating diarrhea and constipation.

How do I take berberine for IBS?

Both berberine containing herbs and pure berberine can be used to treat IBS.

  • Berberine capsules: 400 mg/day

How safe is it?

Berberine may cause some side-effects including low blood pressure, flu-like symptoms, dyspnea and gastrointestinal symptoms. Moreover, pregnant women should avoid berberine as it may cause miscarriage.36

5) Greater Celandine – A potent antispasmodic herb

Greater celandine (Chelidonium majus) is one of the well-known natural remedies for IBS.37 Herbalists use Greater Celandine specifically for digestive issues associated with cramping and gastrointestinal spasms. Although Greater Celandine looks promising for treating IBS there are no human trials available as to date.

Chelidonium - Remedies for IBS

Greater Celandine

How does Greater  Celandine work?

Greater  Celandine contains alkaloids (chelidonine, protopine) very similar in structure to berberine. These compounds have strong antispasmodic38,39, analgesic and anti-inflammatory40,41 effects. All of these actions could potentially decrease symptoms associated with IBS.

How do I take it?

No human studies exist but herbalists typically recommend the following:

• Tincture: 1-2 ml three times a day

How safe is Greater Celandine?

Although Greater Celandine has a long history in herbal medicine, there are several case reports of it causing inflammation of the liver (hepatitis) in some susceptible individuals.42  Although the liver damage was reversible and is relatively rare there does seem to be an association.  Avoid using with patients with liver disease.  It would be prudent to monitor liver enzymes if using it for more than a few weeks.

6) Artichoke – helps relieve both indigestion and IBS

Artichoke is traditionally used as a bitter herb to treat digestive concerns but historically it is not used specifically for IBS. However, research shows artichoke relieves alternating patterns of constipation and diarrhea in IBS patients and also improves concomitant indigestion.43 Moreover, the quality of life was found to be increased by the artichoke extract.

How does artichoke help IBS?

Artichoke contains at least two compounds, cynarine and luteolin that affect the digestive tract. Depending on the content of the extract, artichoke can be useful to both inducing gastrointestinal contraction and relaxation. Although the precise mechanism has not been fully elucidated, studies show artichoke extracts bind to gut serotonin (5-HT3 and 5-HT2) receptors.44

How do I take artichoke?

Capsule: 320-640 mg/day

How safe is artichoke?

Artichoke is often consumed as a vegetable and therefore considered very safe.  Leaf extracts were found to be safe and well-tolerated.45

7) Melatonin – The sleep hormone for IBS

Melatonin is very different than the other natural remedies for IBS because it is a hormone produced in the body. It regulates the circadian rhythm and in particular, it regulates sleep.46  However, most people are unaware that melatonin also plays an important role in the digestive tract. Research studies show that melatonin supplementation improves IBS symptoms including abdominal and rectal pain.47–50 Moreover, quality of life of IBS patients was found to be increased.

How does melatonin improve IBS?

Melatonin receptors reside primarily in the nervous system, but they are also abundant in the gut where they regulate gastrointestinal motility, inflammation, and pain.51 Melatonin supplementation exhibits anxiolytic, antioxidant, anti-inflammatory and regulates motility in the gastrointestinal tract.52 Melatonin treatment, depending on the dose, may either decrease gut motility or increase intestinal transit time.53

How do I take melatonin?

It is best to take melatonin before bed because it causes drowsiness.

  • Melatonin Capsules: 3 mg/day

How safe is melatonin?

Melatonin is safe with only a few side effects including headaches, rashes, and nightmares.54

Summary of Natural Remedies for IBS

Natural treatments for IBS include dietary changes, eradicating infectious causes, and natural supplements.  Although the root cause of IBS should be determined and addressed, many natural remedies for IBS can help improve bowel function and relieve pain and other symptoms.  Probiotics are perhaps the best natural remedy for IBS because they can decrease food sensitivities, improve dysbiosis and normalize bowel function. Certain antispasmodic remedies, including Peppermint Oil, berberine and Greater Celandine, can decrease pain and cramping.  However, Greater Celandine should be used with caution because it can cause liver damage in susceptible individuals.  Artichoke can help improve indigestion and IBS symptoms. Finally, the sleep hormone melatonin has many functions in the body beyond regulating sleep and has been shown in clinical trials to improve IBS.  In addition to the above natural remedies for IBS some people may benefit by taking specific foods for constipation or additional natural laxatives. Although there are many natural remedies for IBS you should consult your naturopathic doctor to help you develop an effective multi-pronged treatment approach.

Author & Photographer: Matt Gowan, BSc, ND
All images are copyright of Matt Gowan ©2017 Reference

Disclaimer: This content is subject to change. The information is intended to inform and educate; it does not replace the medical evaluation, advice, diagnosis or treatment by a healthcare professional. www.nhpassist.com © 2017 NDAssist Inc. and/or its affiliates. All rights reserved.

References: Natural Remedies for IBS

1.
Giannetti E, Maglione M, Alessandrella A, et al. A Mixture of 3 Bifidobacteria Decreases Abdominal Pain and Improves the Quality of Life in Children With Irritable Bowel Syndrome: A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. J Clin Gastroenterol. 2017;51(1):e5-e10. [PubMed]
2.
Majeed M, Nagabhushanam K, Natarajan S, et al. Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study. Nutr J. 2016;15:21. [PubMed]
3.
Baştürk A, Artan R, Yılmaz A. Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A randomized controlled trial. Turk J Gastroenterol. 2016;27(5):439-443. [PubMed]
4.
Jadrešin O, Hojsak I, Mišak Z, et al. Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study. J Pediatr Gastroenterol Nutr. 2017;64(6):925-929. [PubMed]
5.
Cayzeele-Decherf A, Pélerin F, Leuillet S, et al. <i>Saccharomyces cerevisiae</i> CNCM I-3856 in irritable bowel syndrome: An individual subject meta-analysis. World J Gastroenterol. 2017;23(2):336-344. [PubMed]
6.
Pearson J, Whorwell P. Progress with treating the microbial dysbiosis associated with irritable bowel syndrome. Curr Opin Gastroenterol. 2017;33(1):21-25. [PubMed]
7.
Yuan F, Ni H, Asche C, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017;33(7):1191-1197. [PubMed]
8.
Pinto-Sanchez M, Hall G, Ghajar K, et al. Probiotic Bifidobacterium longum NCC3001 Reduces Depression Scores and Alters Brain Activity: A Pilot Study in Patients With Irritable Bowel Syndrome. Gastroenterology. May 2017. [PubMed]
9.
Compare D, Rocco A, Coccoli P, et al. Lactobacillus casei DG and its postbiotic reduce the inflammatory mucosal response: an ex-vivo organ culture model of post-infectious irritable bowel syndrome. BMC Gastroenterol. 2017;17(1):53. [PubMed]
10.
Darbaky Y, Evrard B, Patrier S, et al. Oral probiotic treatment of Lactobacillus rhamnosus Lcr35<sup>®</sup> prevents visceral hypersensitivity to a colonic inflammation and an acute psychological stress. J Appl Microbiol. 2017;122(1):188-200. [PubMed]
11.
Dimidi E, Christodoulides S, Scott S, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017;8(3):484-494. [PubMed]
12.
Zhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterol. 2016;16(1):62. [PubMed]
13.
Kajander K, Myllyluoma E, Rajilić-Stojanović M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther. 2008;27(1):48-57. [PubMed]
14.
Shivaji U, Ford A. Beliefs about management of irritable bowel syndrome in primary care: cross-sectional survey in one locality. Prim Health Care Res Dev. 2015;16(3):263-269. [PubMed]
15.
Mearin F, Ciriza C, Mínguez M, et al. Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult. Rev Esp Enferm Dig. 2016;108(6):332-363. [PubMed]
16.
Ruepert L, Quartero A, de W, van der, Rubin G, Muris J. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2011;(8):CD003460. [PubMed]
17.
Vanuytsel T, Tack J, Boeckxstaens G. Treatment of abdominal pain in irritable bowel syndrome. J Gastroenterol. 2014;49(8):1193-1205. [PubMed]
18.
Cash B, Epstein M, Shah S. A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms. Dig Dis Sci. 2016;61(2):560-571. [PubMed]
19.
Alam M, Roy P, Miah A, et al. Efficacy of Peppermint oil in diarrhea predominant IBS – a double blind randomized placebo – controlled study. Mymensingh Med J. 2013;22(1):27-30. [PubMed]
20.
Khanna R, MacDonald J, Levesque B. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014;48(6):505-512. [PubMed]
21.
McKay D, Blumberg J. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.). Phytother Res. 2006;20(8):619-633. [PubMed]
22.
Harrington A, Hughes P, Martin C, et al. A novel role for TRPM8 in visceral afferent function. Pain. 2011;152(7):1459-1468. [PubMed]
23.
Thompson A, Meah D, Ahmed N, et al. Comparison of the antibacterial activity of essential oils and extracts of medicinal and culinary herbs to investigate potential new treatments for irritable bowel syndrome. BMC Complement Altern Med. 2013;13:338. [PubMed]
24.
Hotz J, Plein K. [Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation]. Med Klin (Munich). 1994;89(12):645-651. [PubMed]
25.
Bijkerk C, de W, Muris J, Whorwell P, Knottnerus J, Hoes A. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154. [PubMed]
26.
Shulman R, Hollister E, Cain K, et al. Psyllium Fiber Reduces Abdominal Pain in Children With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial. Clin Gastroenterol Hepatol. 2017;15(5):712-719.e4. [PubMed]
27.
McRorie J, McKeown N. Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber. J Acad Nutr Diet. 2017;117(2):251-264. [PubMed]
28.
Washington N, Harris M, Mussellwhite A, Spiller R. Moderation of lactulose-induced diarrhea by psyllium: effects on motility and fermentation. Am J Clin Nutr. 1998;67(2):317-321. [PubMed]
29.
Singh B. Psyllium as therapeutic and drug delivery agent. Int J Pharm. 2007;334(1-2):1-14. [PubMed]
30.
Salguero M, Seijas R-C, Hernández N, Caballos V, Díaz P, Ayerbe G-M. [Esophageal obstruction caused by dietary fiber from Plantago ovata, a complication preventable by adequate information]. Gastroenterol Hepatol. 2003;26(4):248-250. [PubMed]
31.
Chen C, Yu Z, Li Y, Fichna J, Storr M. Effects of berberine in the gastrointestinal tract – a review of actions and therapeutic implications. Am J Chin Med. 2014;42(5):1053-1070. [PubMed]
32.
Chen C, Tao C, Liu Z, et al. A Randomized Clinical Trial of Berberine Hydrochloride in Patients with Diarrhea-Predominant Irritable Bowel Syndrome. Phytother Res. 2015;29(11):1822-1827. [PubMed]
33.
Tang Q, Lai M, Zhong Y, Wang A, Su J, Zhang M. Antinociceptive effect of berberine on visceral hypersensitivity in rats. World J Gastroenterol. 2013;19(28):4582-4589. [PubMed]
34.
Chen C, Lu M, Pan Q, et al. Berberine Improves Intestinal Motility and Visceral Pain in the Mouse Models Mimicking Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D) Symptoms in an Opioid-Receptor Dependent Manner. PLoS One. 2015;10(12):e0145556. [PubMed]
35.
Chen D, Xiong Y, Lv B, et al. Effects of berberine on rat jejunal motility. J Pharm Pharmacol. 2013;65(5):734-744. [PubMed]
36.
Derosa G, Maffioli P, Cicero A. Berberine on metabolic and cardiovascular risk factors: an analysis from preclinical evidences to clinical trials. Expert Opin Biol Ther. 2012;12(8):1113-1124. [PubMed]
37.
Abascal K, Yarnell Y. Combining Herbs in a Formula for Irritable Bowel Syndrome. Alternative and Complementary Therapies. http://online.liebertpub.com/doi/abs/10.1089/act.2005.11.17?journalCode=act. Accessed July 20, 2017. [Source]
38.
Boegge S, Kesper S, Verspohl E, Nahrstedt A. Reduction of ACh-induced contraction of rat isolated ileum by coptisine, (+)-caffeoylmalic acid, Chelidonium majus, and Corydalis lutea extracts. Planta Med. 1996;62(2):173-174. [PubMed]
39.
Hiller K, Ghorbani M, Schilcher H. Antispasmodic and relaxant activity of chelidonine, protopine, coptisine, and Chelidonium majus extracts on isolated guinea-pig ileum. Planta Med. 1998;64(8):758-760. [PubMed]
40.
Kim D, Kim S, Kim M, Jeon Y, Um J, Hong S. The therapeutic effect of chelidonic acid on ulcerative colitis. Biol Pharm Bull. 2012;35(5):666-671. [PubMed]
41.
Mikołajczak P, Kędzia B, Ożarowski M, et al. Evaluation of anti-inflammatory and analgesic activities of extracts from herb of Chelidonium majus L. Cent Eur J Immunol. 2015;40(4):400-410. [PubMed]
42.
Stickel F, Pöschl G, Seitz H, Waldherr R, Hahn E, Schuppan D. Acute hepatitis induced by Greater Celandine (Chelidonium majus). Scand J Gastroenterol. 2003;38(5):565-568. [PubMed]
43.
Bundy R, Walker A, Middleton R, Marakis G, Booth J. Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. J Altern Complement Med. 2004;10(4):667-669. [PubMed]
44.
Verspohl E, Ploch M, Windeck T, Klaes M, Schmidt T, Bauer K. Effect of two artichoke extracts (36_U and 36_EB) on rat ileum (with respect to bowel syndrome) and the peristaltic threshold. Phytomedicine. 2008;15(11):1002-1009. [PubMed]
45.
Walker A, Middleton R, Petrowicz O. Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study. Phytother Res. 2001;15(1):58-61. [PubMed]
46.
Tordjman S, Chokron S, Delorme R, et al. Melatonin: Pharmacology, Functions and Therapeutic Benefits. Curr Neuropharmacol. 2017;15(3):434-443. [PubMed]
47.
Song G, Leng P, Gwee K, Moochhala S, Ho K. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut. 2005;54(10):1402-1407. [PubMed]
48.
Lu W, Gwee K, Moochhalla S, Ho K. Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2005;22(10):927-934. [PubMed]
49.
Saha L, Malhotra S, Rana S, Bhasin D, Pandhi P. A preliminary study of melatonin in irritable bowel syndrome. J Clin Gastroenterol. 2007;41(1):29-32. [PubMed]
50.
Chojnacki C, Walecka-Kapica E, Lokieć K, et al. Influence of melatonin on symptoms of irritable bowel syndrome in postmenopausal women. Endokrynol Pol. 2013;64(2):114-120. [PubMed]
51.
Chen C, Fichna J, Bashashati M, Li Y, Storr M. Distribution, function and physiological role of melatonin in the lower gut. World J Gastroenterol. 2011;17(34):3888-3898. [PubMed]
52.
Mozaffari S, Rahimi R, Abdollahi M. Implications of melatonin therapy in irritable bowel syndrome: a systematic review. Curr Pharm Des. 2010;16(33):3646-3655. [PubMed]
53.
Esteban-Zubero E, López-Pingarrón L, Alatorre-Jiménez M, et al. Melatonin’s role as a co-adjuvant treatment in colonic diseases: A review. Life Sci. 2017;170:72-81. [PubMed]
54.
Siah K, Wong R, Ho K. Melatonin for the treatment of irritable bowel syndrome. World J Gastroenterol. 2014;20(10):2492-2498. [PubMed]