Alternative and Integrative Therapies for Inflammatory Bowel Disease

Good Scientific Evidence :

Probiotics : E. coli Nissle 1917 appears to be as effective as the drug mesalamine in the treatment of ulcerative colitis. However, it is not currently available in the United States. A variety of Bifidophilus preparations have shown effects of preventing relapse or maintaining remission. These include Bifidophilus alone, Bifidophilus in fermented milk products, and a synbiotic preparation. A probiotic combination consisting of VSL#3 plus balsalazide may be more effective than balsalazide or mesalamine alone. More studies are needed to more clearly determine what outcomes can be expected. Probiotics are generally regarded as safe for human consumption. Long–term consumption of probiotics is considered safe and well tolerated.

Unclear or Conflicting Scientific Evidence :

Acupuncture : Acupuncture appears to be safe when used in decreasing inflammation and pain associated with IBD, although scientific evidence is inconclusive about its effectiveness. Avoid acupuncture in patients who have valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in the elderly or medically compromised patients, diabetics or with history of seizures.

Acustimulation : Acustimulation is the mild electrical stimulation of acupuncture points to control symptoms such as nausea and vomiting. One small study suggests that acustimulation may help reduce inflammation and pain caused by IBD. The only known side effect of acustimulation devices is slight skin irritation under the electrodes when the wristband is used. Switch wrists to avoid. Acustimulation devices should only be used on the designated area. Use cautiously with pacemakers. Avoid if the cause of medical symptoms is unknown. Keep acustimulation devices out of the reach of children.

Aloe : There is limited but promising research of the use of oral aloe vera in ulcerative colitis (UC), compared to placebo. It is not clear how aloe vera compares to other treatments used for UC. People with known allergy to garlic, onions, tulips, or other plants of the Liliaceae family may have allergic reactions to aloe. Individuals using aloe gel for prolonged times have developed allergic reactions including hives and eczema–like rash. Although topical (skin) use of aloe is unlikely to be harmful during pregnancy or breastfeeding, oral (by mouth) use is not recommended due to theoretical stimulation of uterine contractions. It is not known whether active ingredients of aloe may be present in breast milk. Breastfeeding mothers should not consume the dried juice of aloe leaves.

Barley : Germinated barley foodstuff (GBF) comes from maturing barley, and has been suggested as possibly helpful in patients with ulcerative colitis. Scientific evidence in this area is preliminary, and further research is needed before GBF can be recommended for ulcerative colitis. Patients who are allergic to barley flour or beer should avoid barley products. Severe allergic reactions (anaphylaxis) and skin rashes have been reported from drinking beer made with malted barley. Patients with allergy/hypersensitivity to grass pollens, rice, rye, oats or wheat may also react to barley. Barley appears to be well tolerated in non–allergic, healthy adults in recommended doses for short periods of time, as a cereal or in the form of beer. Avoid consuming large amounts of barley sprouts if pregnant. Avoid if breastfeeding.

Boswellia : Boswellia has been noted in animal and laboratory studies to possess anti–inflammatory properties. Based on these observations, boswellia has been suggested as a potential treatment for ulcerative colitis. At this time, however, only a limited number of poor–quality human trials have evaluated this use of boswellia, with inconclusive results. Therefore, there is inadequate evidence for or against this use of boswellia. Avoid if allergic to boswellia or other herbs in the Burseraceae family (like myrrh or garuga). Boswellia is generally believed to be safe when used as directed, although safety and toxicity have not been well studied in humans. Indian literature suggests that boswellia may promote menstruation and induce abortion. However, there is insufficient scientific evidence regarding the safety of boswellia. Therefore, pregnant or breastfeeding women should avoid boswellia.

DHEA : Initial research reports have shown that DHEA (dehydroepiandrosterone) supplements are safe for short–term use in patients with Crohn's disease. Preliminary research suggests possible beneficial effects, although further research is necessary before a clear conclusion can be drawn. Avoid if allergic to DHEA products. Avoid if pregnant or breastfeeding because DHEA is a hormone.

Gamma linolenic acid (GLA) : One double blind, randomized clinical trial suggests that a combination of GLA plus eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) does not prolong the period of disease remission in ulcerative colitis. Further well–designed clinical trials are required in this area before recommendations can be made. GLA is generally considered nontoxic and well tolerated for up to 18 months. Avoid if pregnant or breastfeeding due to insufficient evidence.

Glucosamine : Preliminary research reports improvements with N–acetyl glucosamine as an added therapy in inflammatory bowel disease. Further scientific evidence is necessary before a recommendation can be made. Avoid if allergic to shellfish or iodine. In most human studies, glucosamine sulfate has been well tolerated for 30 to 90 days. Avoid if pregnant or breastfeeding.

Moxibustion : One study suggests acupuncture combined with moxibustion (burning dried herbs, sometimes with glass cups or bowls, on the surface of the skin) may benefit symptoms in Crohn's disease. Well–designed studies are needed to verify this finding before concrete recommendations can be made.

Omega–3 fatty acids : It has been suggested that effects of omega–3 fatty acids on inflammation may be beneficial in patients with ulcerative colitis when added to standard therapy, and several studies have been conducted in this area. Better research is necessary before a clear conclusion can be drawn.

It has also been suggested that effects of omega–3 fatty acids on inflammation may be beneficial in patients with Crohn's disease when added to standard therapy, and several studies have been conducted in this area. Results are conflicting, and no clear conclusion can be drawn at this time. Avoid if allergic to fish. The U.S. Food and Drug Administration classifies low intake of omega–3 fatty acids from fish as GRAS (Generally Regarded as Safe). Caution may be warranted, however, in diabetic patients due to potential (albeit unlikely) increases in blood sugar levels, patients at risk of bleeding, or in those with high levels of low–density lipoprotein (LDL). Fish meat may contain methylmercury, and caution is warranted in young children and pregnant/breastfeeding women.

Psychotherapy : Psychotherapy may not improve the course of Crohn's disease, although patients undergoing psychotherapy tended to have fewer operations and relapses. More research in this area is needed.

Psyllium : There is limited and unclear evidence regarding the use of psyllium in patients with inflammatory bowel disease. Serious allergic reactions including anaphylaxis, difficulty breathing/wheezing, skin rash, and hives have been reported after ingestion of psyllium products. Less severe hypersensitivity reactions have also been noted. Cross–sensitivity may occur in people with allergy to English plantain pollen (Plantago lanceolata), grass pollen, or melon. Psyllium appears to be safe during pregnancy and breastfeeding.

Reflexology : Reflexology involves the application of manual pressure to specific points or areas of the feet that are believed to correspond to other parts of the body. Reflexology is often used with the intention to relieve stress or prevent/treat physical disorders. Reflexology may help relieve IBD symptoms. However, more research is necessary before recommendations can be made. Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.

Saccharomyces boulardii : Evidence supports mild improvement of symptoms and quality of life in patients with Crohn's disease who use Saccharomyces boulardii, although studies have been small. The pathogenesis of Crohn's disease may involve genetically influenced dysregulation of the mucosal immune response to antigens present in normal bacterial flora. Probiotics may change the enteric microenvironment, thereby alleviating the misguided immune response. More clinical trials are required before recommendations can be made in this field. Avoid if allergic to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Saccharomyces boulardii has been generally well tolerated in human studies for up to 15 months. However, Saccharomyces boulardii fungemia does occur. Multiple case reports describe fungemia in patients taking Saccharomyces boulardii. Avoid if pregnant or breastfeeding.

Soy : Due to limited human study, there is not enough evidence to recommend for or against the use of soy as a therapy in preventing Crohn's disease. Further research is needed before a recommendation can be made. Soy can act as a food allergen similar to milk, eggs, peanuts, fish, and wheat. Soy has been a dietary staple in many countries for over 5,000 years, and is generally regarded as not having significant long–term toxicity. Limited side effects have been reported in infants, children, and adults aside from allergic reactions. Soy as a part of the regular diet is traditionally considered to be safe during pregnancy and breastfeeding, although scientific research is limited in these areas.

Thiamin (vitamin B1) : Decreased serum thiamine levels have been reported in patients with Crohn's disease. It is not clear if routine thiamin supplementation is beneficial in such patients generally. Allergic reactions to thiamin supplements are rare. A small number of life–threatening anaphylactic reactions have been observed with large parenteral (intravenous, intramuscular, subcutaneous) doses of thiamin, generally after multiple doses. Thiamin is generally considered safe and relatively nontoxic, even at high doses. Thiamin appears to be safe at recommended doses during pregnancy and breastfeeding.

Wheatgrass : One well–designed study reported potential benefits of wheatgrass in the treatment of ulcerative colitis. However, further research is needed to confirm these findings. Wheatgrass is generally considered safe, but should be avoided in patients who are allergic to it. Because it is grown in soils or water and consumed raw, wheatgrass may be contaminated with bacteria, molds or other substances. Because it is grown in soils or water and consumed raw, wheatgrass may be contaminated with bacteria, molds or other substances. Theoretically, women who are pregnant or breastfeeding should use wheatgrass cautiously.

Zinc : Preliminary research of zinc supplements in patients with Crohn's disease has yielded positive results. However, one small study found that zinc supplementation does not seem to improve inflammatory bowel disease. Well–designed clinical trials are needed to confirm these results. Zinc is regarded as a relatively safe and generally well tolerated when taken at recommended doses, and few studies report side effects. Occasionally adverse affects such as nausea, vomiting, or diarrhea has been observed. Zinc acetate should only be used during pregnancy if clearly needed. Zinc appears to be safe in amounts that do not exceed the established tolerable upper intake level. Zinc chloride should be given to a pregnant woman only if clearly needed under medical supervision.

Traditional or Theoretical Uses Lacking Sufficient Evidence :

Homeopathy : Homeopathy may be helpful for helping balance immune function and decreasing symptoms of IBD. Further research is needed before recommendations can be made. Safety and effectiveness are not well studied, although most homeopathic practitioners regard these approaches as safe. Aside from rare adulteration of commercial products, there are no published reports of serious adverse effects. Severe or chronic health conditions may require additional medical attention beyond homeopathy.

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