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Good scientific evidence:
Fennel: Fennel grows in the Mediterranean region. For centuries, fennel fruits have been used as herbal medicines in Europe and China. Fennel tea is often used to treat infants with digestive disorders. It has a mild flavor and seems to be well-tolerated. An emulsion of fennel seed oil and an herbal tea containing fennel have reduced infantile colic. Additional studies are warranted in order to confirm these findings. Avoid if allergic or hypersensitive to fennel or other members of the Apiaceae family. Fennel is generally well-tolerated. However, serious allergic reactions may occur. Use cautiously with diabetes. Avoid with epilepsy. Avoid in infants and toddlers. Avoid if pregnant or breastfeeding. Hypnosis, hypnotherapy: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions or to change behaviors. Early research suggests that hypnotherapy may lower the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome. Better studies are necessary to make a strong recommendation. Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders. Peppermint: Peppermint is a flowering plant that grows throughout Europe and North America. Peppermint is most often grown for its fragrant oil. Peppermint may improve irritable bowel syndrome (IBS) symptoms. Additional study is necessary before a strong recommendation can be made. Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. However, doses of menthol greater than 1 gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding. Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. Many varieties and combinations of probiotics have been studied in clinical trials for irritable bowel syndrome (IBS). Findings frequently report reductions of symptoms including pain, flatulence, bloating, and stool frequency. There is some evidence of reduced inflammation. The magnitude of benefit seen in most studies is modest. Not all studies, however, show beneficial effects. More studies are needed to determine the best protocols and what level of benefit can be expected. Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber and is the main ingredient in many commonly used laxatives, such as Metamucil® and Serutan®. Psyllium has long been used as a chief ingredient in "bulk laxatives." Generally, an increase in stool weight, an increase in bowel movements per day, and a decrease in total gut transit time has been observed in most studies. Psyllium has been studied for the treatment of diarrhea, particularly in patients undergoing tube feeding. It has also been studied in addition to Orlistat® therapy in hopes of decreasing gastrointestinal effects (diarrhea and oily discharge) of this weight loss agent. An effective stool bulking effect has generally been found in scientific studies. Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium. Use cautiously if pregnant or breastfeeding because psyllium may lower blood sugar levels.
Unclear or conflicting scientific evidence:
Acupressure, shiatsu: During acupressure, finger pressure is applied to specific acupoints on the body. Acupressure is used around world for relaxation, wellness promotion, and the treatment of many health problems. A small study suggests that acupressure may improve gastrointestinal motility. Additional research is necessary before a firm conclusion can be drawn. With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising. Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Illness and symptoms are thought to be caused by problems in the circulation of chi through the meridians. Although limited evidence suggests benefit may be possible, more studies are needed in order to make recommendations for or against acupuncture in irritable bowel syndrome (IBS). Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Avoid if taking drugs that increase the risk of bleeding (anticoagulants). Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers. Acustimulation: Acustimulation is different from acupuncture. However, Chinese acupuncture theory is used in acustimulation to locate points on the body where electrical stimulation is applied to reduce certain symptoms. Nausea and vomiting are believed to be the result of a disturbance in the normal nerve impulses passing between the brain and stomach. Acustimulation uses a mild electrical current at the wrist to restore normal signals between the brain and stomach, thus reducing nausea and vomiting. Conventional explains acustimulation in terms of the nervous system rather than the circulation of chi, which is the basis of Chinese acupuncture theory. However, the chi pathways ("meridians") have certain parallels with the nervous system. This makes it possible to use acupuncture points to identify locations where electrical stimulation may influence certain responses of the nervous system. One small study suggests that acustimulation to the P6 wrist point and the ST36 point below the knee may help reduce symptoms and pain in patients with irritable bowel syndrome (IBS). However, the design was weak and more studies are needed to determine benefits in IBS. The only known side effect of acustimulation devices is slight skin irritation under the electrodes when the wristband is used. Switch wrists to prevent this from happening. 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. Agrimony: Agrimony was one of the most famous vulnerary herbs with anti-inflammatory and diuretic properties. The tannin content is responsible for many of its medicinal uses. The dried leaves can be used to make tea for drinking or as a throat gargle. Agrimony has been used for many gastrointestinal conditions such as appendicitis, mild diarrhea, stimulation of appetite, and ulcers. Additional human study is needed to make a firm recommendation. Avoid if allergic or hypersensitive to agrimony. Avoid with diarrhea that is caused by an underlying disease. Agrimony should only be used for mild and acute diarrhea. Avoid in patients who are susceptible to constipation. Use cautiously if taking anticoagulants or blood pressure lowering drugs. Avoid if pregnant or breastfeeding. Ayurveda: Ayurveda is a form of natural medicine that originated in ancient India more than 5,000 years ago. Ayurveda is an integrated system of techniques that uses diet, herbs, exercise, meditation, yoga, and massage or bodywork to achieve optimal health on all levels. A compound Ayurvedic preparation with Aegle marmelos correa and Bacopa monniere Linn is a traditional herbal preparation used for digestive disturbances and diarrhea. There is evidence from one study suggesting that this combination may have short-term benefits for patients with IBS, especially those with diarrhea. However, benefits may not be maintained in the long term. More studies are needed to evaluate this treatment. There is preliminary evidence that the herb amalaki (Emblica officinalis / Phyllanthus emblica), a fruit used in a variety of Ayurvedic remedies including the popular general tonic Chyavanaprash, may reduce symptoms of gastritis and dyspepsia (upset stomach). There is also evidence that the Ayurvedic herb Asparagus racemosus (Shatavari) may reduce gastric emptying time at a rate comparable to that of the drug metoclopramide, which is commonly used for dyspepsia. Some of this research has been with healthy subjects however, and further clinical trials are needed using the above remedies to evaluate their efficacy. Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods, or drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. Avoid sour food, alcohol, and heavy exercise with guggul. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag and amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages, and medical conditions that require surgery. Bacopa (Bacopa monnieri): Bacopa monnieri leaf extract is called brahmi in Ayurvedic medicine. It is widely used in India, especially for enhancing memory, pain relief, and epilepsy. Preliminary evidence suggests that bacopa and bael fruit used in combination may treat irritable bowel syndrome (IBS). However, additional studies using bacopa alone are needed before bacopa can be recommended for IBS. Avoid if allergic/hypersensitive to Bacopa monnieri, its constituents, or any member of the Srcophulariaceae (figwort) family. Use cautiously with drugs or herbs that are broken down by the liver, thyroid drugs, calcium blocking drugs, or sedatives. Avoid if pregnant or breastfeeding. Belladonna: Belladonna has been used for centuries to treat many medical conditions. Belladonna has been used historically for the treatment of irritable bowel syndrome and in theory its mechanism of action should be effective for some of the symptoms. However, of the few studies that are available, none clearly show that belladonna alone (not as part of a mixed product) provides this effect. Avoid if allergic to belladonna or plants of the Solanaceae (nightshade) family (e.g. bell peppers, potatoes, or eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat (arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy (enlarged prostate), urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren's syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular disorders such as myasthenia gravis, or Down's syndrome. Avoid if pregnant or breastfeeding. Chamomile: Chamomile is an herb that has an apple-like smell and taste. Chamomile is a common tea. Chamomile is used traditionally for numerous gastrointestinal conditions including digestion disorders, "spasm" or colic, upset stomach, flatulence (gas), ulcers, and gastrointestinal irritation. However, currently there is no reliable human research available in any of these areas. Additional study is needed. Chamomile is reputed to have anti-spasmodic activity, but there is little research to substantiate this claim. Additional research evaluating chamomile alone is needed. Avoid if allergic to chamomile or any related plants such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding. Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques including spinal manipulative therapy, diet, exercise, X-rays, and others (e.g. interferential and electrogalvanic muscle stimulation). There is not enough reliable scientific evidence to make a conclusion about the effects of chiropractic techniques in the management of infantile colic Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, and migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid if taking drugs that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Clay: Clay has been used medicinally for centuries in Africa, India, and China. There is not enough scientific evidence to recommend the medicinal use of clay by mouth in patients with gastrointestinal disorders. Some clay preparations have been found to be similar to Kaolin® and Kaopectate®, which are used to treat gastrointestinal disturbances, including diarrhea. However, overall, there are significant potential risks that accompany the use of clay, including intestinal blockage and injury and lead poisoning. There is not enough scientific research to support a recommendation for play with modeling clay as an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence). There are no reports of allergy to clay in the available scientific literature. However, in theory, allergy/hypersensitivity to clay, clay products, or constituents of clay may occur. Avoid if pregnant or breastfeeding. Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, and fruits, shellfish, avocado, beef, and animal organs. Menkes' kinky-hair disease is a rare disorder of copper transport/absorption. Copper supplementation may be helpful in this disease, although further research is necessary before a clear management recommendation can be made. Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, genetic disorders affecting copper metabolism (e.g. Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis), or HIV/AIDS. Use water cautiously if it contains more than six milligrams of copper per liter. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking birth control pills. Use cautiously if at risk for selenium deficiency. The U.S. recommended dietary allowance (RDA) is 1,000 micrograms for pregnant women. The RDA is 1,300 micrograms for nursing women. Globe artichoke: Globe artichoke is a popular phytomedicine in Europe. It is purported to possess diuretic, choleretic, anti-dyspeptic, lipid-lowering, and antioxidant properties. There is insufficient available evidence to recommend for or against the use of artichoke in relieving the symptoms of irritable bowel syndrome. Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae families (e.g. chrysanthemums, daisies, marigolds, ragweed, or arnica), due to possible cross-reactivity. Use cautiously with cholelithiasis, biliary/bile duct obstruction, or kidney disease. Avoid if pregnant or breastfeeding. Hypnosis, hypnotherapy: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions or to change behaviors. Early research indicates that gut-oriented hypnosis may have a beneficial effect on shortening gastric emptying both in dyspeptic and in healthy subjects. Additional study is needed before a firm conclusion can be drawn. Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorders, or dissociative disorders) or seizure disorders. Lactobacillus acidophilus: Lactobacilli are bacteria that normally live in the human small intestine and vagina. Human studies report mixed results in the improvement of irritable bowel syndrome (IBS) symptoms after taking Lactobacillus acidophilus by mouth. One human study using L. acidophilus in combination with another bacterium (B. infantis) in infants reported fewer cases of necrotizing enterocolitis (severe inflammation of the gut) and no complications related to treatment. Additional research is necessary in this area before a conclusion can be drawn. Lactobacillus acidophilus may be difficult to tolerate if allergic or hypersensitive to dairy products. Avoid with a history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid if taking prescription drugs, such as corticosteroids, because there is a risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus. Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids, such as famotidine (Pepcid®) or esomeprazole (Nexium®), to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus. Lycopene: Lycopene is a carotenoid found in tomatoes. It is also present in human serum, liver, adrenal glands, lungs, prostate, colon, and the skin. Multiple studies have examined whether intake of tomatoes or tomato-based products helps prevent digestive tract cancers including oral, pharyngeal, esophageal, gastric, colon, and rectal. Results have been inconsistent, with some studies reporting significant benefits and others finding no effects. Research that specifically studies lycopene supplements is limited, and more research is needed in this area before a conclusion can be drawn. Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding. Peppermint oil: Peppermint is a flowering plant that grows throughout Europe and North America. Peppermint is most often grown for its fragrant oil. There is currently a lack of sufficient evidence to recommend for or against the use of a peppermint oil compress for abdominal distention. Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. However, doses of menthol greater than one gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding. Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber and is the main ingredient in many commonly used laxatives (like Metamucil® and Serutan®). Psyllium preparations have been studied for more than 20 years in the treatment of irritable bowel syndrome symptoms. Results of these trials have been conflicting. In some cases, insoluble fiber may worsen the clinical outcome. Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium. Use cautiously if pregnant or breastfeeding because psyllium may lower blood sugar levels. 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. Preliminary study of reflexology in humans with irritable bowel syndrome has not yielded definitive results.Better research is needed in this area before a recommendation 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, pacemakers, 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. Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus. Early research in humans suggests that relaxation may aid in the prevention and relief of irritable bowel syndrome (IBS) symptoms. Large, well-designed trials are needed to confirm these results. Avoid with psychiatric disorders such as schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses such as heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time to diagnosis or treatment with more proven techniques. Rhubarb: In traditional Chinese medicine (TCM), rhubarb is used as an ulcer remedy and it is considered a bitter, cold, dry herb used to "clear heat" from the liver, stomach, and blood. One double-blind controlled trial examined the effect of the herbal extract "Amaro Medicinale Giuliani" and its constituents, including rhubarb, on mild gastrointestinal disturbances. Although the herbal extract and a combination of rhubarb and gentian seem promising, higher quality studies with rhubarb as a monotherapy are need to discern rhubarb's effect on gastrointestinal disturbances. Avoid if allergic/hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, kidney disorders, ulcerative colitis, or urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children under age 12 due to water depletion. Use cautiously with bleeding disorders, heart conditions, coagulation therapy, constipation, or with a history of kidney stones or thin or brittle bones. Use cautiously if taking anti-psychotic drugs or oral drugs, herbs, or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding. Saccharomyces boulardii: Saccharomyces boulardii is a type of yeast that does not cause disease in humans. One clinical trial exists to support treatment with Saccharomyces boulardii for irritable bowel syndrome. Additional study is required before a firm recommendation can be made Avoid if allergic or hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding. Selenium: Selenium is a mineral found in soil, water, and some foods. Low selenium status has been demonstrated in several malabsorptive syndromes and in some digestive and gastrointestinal allergic conditions. There is some evidence that children with food allergies have a higher risk of selenium deficiency. There is no clear benefit of selenium supplementation as a therapy for malabsorptive syndromes, although vitamin supplementation in general may be warranted. Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects. Slippery elm: Slippery elm is native to eastern Canada and the eastern and central United States. Its name refers its slippery consistency when the inner bark is chewed or mixed with water. Slippery elm has been traditionally used to treat inflammatory conditions of the digestive tract such as gastritis, peptic ulcer disease, and enteritis. It may be taken alone or in combination with other herbs. Additional study is needed in this area before a clear conclusion can be drawn. Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding. TENS (transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. There is conflicting evidence from clinical trials on the effectiveness of TENS in post-operative ileus. Well-designed, large studies are needed before a recommendation can be made. Avoid with implantable devices such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (e.g. neuropathy) or seizure disorders. Avoid if pregnant or breastfeeding. Copyright© 2007 Natural Standard Inc.
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