Natural treatments for IBS include various dietary recommendations, lifestyle adjustments and possibly herbal medicines and supplements. While prescription medications may sometimes be needed, they are often used as a sort of “stop-gap” measure until the dietary recommendations, lifestyle modifications and whatever herbal medicines and/or supplements begin to show some effectiveness.
Some Common Medications Used in IBS
Since it is not clear what the exact cause of IBS is—and since IBS can have different forms, including diarrhea-predominant, constipation-predominant, alternating and mixed—treatment is based on the relief of symptoms. Fiber supplements are often recommended for both diarrhea and constipation-predominant forms of IBS. Anti-depressants and anti-anxiety medications are used with some success. Medications that can be used depend on the type of IBS. These can be anti-diarrheal medications such as OTC loperimide (Imodium) and prescription Lomotil (Lomotil contains atropine and diphenoxylate). Other medications used for IBS-D include hyoscyamine (Levsin) and dicyclomine (Bentyl) that function as antispasmotics. Hyosyamine can cause constipation or diarrhea, a dry mouth, urinary problems, changes in heart rate and palpitations, impotence, abdominal pain and neurological conditions affecting movement, memory, and cognitive function. Dicyclomine can cause constipation, bloating, worsening diarrhea, difficulty urination, palpitations, blurry vision, difficulty urinating and other effects. Other medications commonly used include bile acid binders such as cholestyramine (Prevalite, Questran), colestipol (Colestid) or colesevelam (Welchol). As an example, cholestyramine can cause blood in the urine, constipation, shortness of breath, black or bloody stools, diarrhea, bloating, and stomach pain, among other side effects. Many of these side effects are quite rare, it is true, but if YOU are the one experiencing them, that rarity may be less important to you. may sometimes be needed, but some of the common medications used can cause significant side effects.
There are some newer medications that are more targeted to IBS. You should know that while these drugs have been tested and approved for IBS, the fact is that over time, the knowledge about how these drugs work increases—often, that is good news, but it can also mean that the known adverse effects may become more obvious and sometimes necessitates the removal of the drug from the market. For example, alosetron was removed from the market in 2001 and then re-approved in 2002 with more restricted approved uses.
- Alosetron hydrochloride (Lotronex) is a selective 5HT3 receptor antagonist, which means it blocks the action of 5HT at a specific type of receptor on the surface of intestinal cells, which slows down the movement of material through the intestines. It is approved for use in some women with IBS-D. Lotronex can cause decreased blood flow through the intestines (ischemic colitis) and severe constipation.
- Rifaximin (Xifaxan) is an antibiotic and is used to treat IBS-D, altering the bacteria in the intestines. It doesn’t pass into the bloodstream, so Rifaximin only kills bacteria in the intestines. The treatment course is somewhat variable—some people find relief after one course of a 10-14day treatment, while others need longer treatments. The most common side effects include gas, abdominal pain, rectal spasms and diarrhea.
- Eluxadoline (Viberzi) is an opioid mixed agonist/antagonist which means that it blocks some opioid receptors and activates other opioid receptors. It can reduce pain and discomfort in IBS-D, usually without causing constipation. Common side effects include abdominal pain, constipation, nausea and vomiting.
- Lubiprostone (Amitiza) increases intestinal motility (peristalsis) by acting on chloride “gates” in the cells of the intestine. It is currently approved for women with IBS-C and in both men and women with chronic constipation. Side effects include diarrhea, headaches, nausea, abdominal pain, urinary tract infections and gassiness.
- Linaclotide (Linzess/Constella) increases the secretion of chloride and water into the intestines and blocks pain signals in the intestines. It is approved for men and women with IBS-C and for adults with chronic constipation. Side effects include diarrhea, gassiness and abdominal pain.
It is important to remember that many of these side effects are relatively rare. This is true, but if YOU are the one experiencing them, that rarity may be less important to you. It is always important that you tell your physician ALL the prescription medications AND any supplements (including herbs, nutraceuticals, vitamins and minerals) that you are taking. Most people think that if it natural, it is fine to take. Much of the time, this is true, but it is not always true—many herbs affect the same systems that prescription drugs do and use the same metabolic pathways. Sometimes these herbs and nutraceuticals (supplements) can increase OR decrease the effects of the drugs. This is obviously important to know! Your pharmacist is also a great resource to check for interactions.
Natural Treatment Approaches to IBS
Natural treatment approaches to IBS involve dietary approaches increasing dietary fiber (usually from fruit and vegetable sources), finding and eliminating food sensitivities, using a number of supplements and botanical medicine and controlling the psychological aspects of IBS.
As mentioned, dietary fiber should be from either fruit or vegetable sources, keeping in mind that individuals may have sensitivities to the source of the fiber—in other words, if someone has wheat sensitivities, the source of fiber should not, of course, be wheat bran! In some cases, fiber may increase diarrhea—in this case, working with soluble versus insoluble fiber or utilizing resistant starches as a source of fiber may prove beneficial.  30 grams per day is often recommended, though that amount can be increased or decreased depending on the individual’s response. If fiber sensitivity is suspected, a hypoallergenic substitute, partially hydrolyzed guar gum (PHGG), a soluble fiber, has been recommended. 
A diet diary can form the basis for specific food elimination. The diet diary is kept for at least 1-2 weeks, along with all symptoms experienced. This diet diary can be used to determine which foods should be eliminated. For example, if an individual has a fatty meal and experiences diarrhea consistently after that meal, fatty foods should be considered for elimination. Foods that most commonly cause problems in IBS include those rich in carbohydrates, high in fats, coffee, alcohol and hot spices (eg. hot curries). 5 Gluten (in wheat products) and casein (a dairy protein) are also common culprits. Foods can often be removed as a group—for example, one can relatively easily remove fatty and fried foods from the diet without a great deal of difficulty or nutritional loss. Functionally, it is often easier to remove smaller groups—one can, for example, eliminate wheat-based pasta from the diet without removing all forms of pasta. Food should be eliminated for a minimum of 3-4 weeks, though many natural physicians recommend 6-8 weeks to allow for healing. These foods can (after the elimination period) be re-introduced. Many people however find it is best to remove symptom-causing foods permanently.
Sugar is considered a drug by many natural physicians. There are, it is true, many similarities between the actions of high-sugar foods and some drugs. However, glucose (a sugar) is THE essential fuel for the body, especially the brain. We do need sugar—the problem is likely in the form and the amount of sugar so many in the modern world ingest. Currently, the best advice is to cut back significantly on processed foods that contain added sugars (most processed foods do) and to limit the sugary foods such as doughnuts, candies, cakes, pies and commercially made breads and pastries. The easiest (or at least the simplest) way to do this is to avoid all processed foods—once you start reading the labels, you will likely be surprised (Shocked? Appalled? Stunned?) to see just how much sugar is added. Avoiding processed foods has other advantages for anyone with IBS as well. Higher sugar intakes are directly related to diabetes. If your IBS is SIBO (Small Intestinal Bacterial Overgrowth) related, avoiding sugar can help starve those bacteria. Normal gut bacteria (see below) do not do well with high sugar diets. High sugar diets can significantly impact how the intestines function and how fast contents travel through the gut—high sugar diets are associated with a slower transit time.5,
FODMAPs (Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols) are foods that contain short-chain carbohydrates that can be fermented by gut bacteria and produce large amounts of gas. Avoiding these foods is a very common natural approach to treating IBS.
Probiotics and Prebiotics
Probiotics are a sort of bacteria-replacement-therapy and have provided benefit for patients with IBS, though many of the studies used a limited set of bacteria. There are a variety of bacteria in a mutually beneficial relationship that live in the gut—these bacteria produce vitamins and are critical in “training” our immune system. Enough beneficial bacteria can, in theory, “crowd out” non-beneficial bacteria. Gut bacteria also produce anti-inflammatory short-chain fatty acids such as butyric acid, also used as a source of fuel for intestinal cells. There is no “recommended dose” for probiotics—follow manufacturer’s directions, but look for supplements with at least the bacterial groups Lactobacillus acidophilus, L. fermentum, L. rhamnosus, Bifidobacteria longum and bifidum and Bacillus strains. There should be at least 50 billion CFUs (Colony Forming Units) in each dose.
Prebiotics are foods that support healthy bacteria in the gut. Pro- and prebiotic foods include fermented (non-pasteurized) foods such as sauerkraut, kimchee, yogurt, sourdough bread, home-made pickles and the fermented beverage, kefir. Prebiotic foods include Jerusalem artichokes, chicory, garlic, onions, leeks, asparagus, beetroot, chickpeas and lentils. You should know that many pre-biotic foods are also relatively high FODMAPs foods, so limit the intake—but a little does go a long way in this case.
Peppermint oil has been studied and been found to stabilize bowel movements (in both diarrhea and constipation-predominant forms) and to reduce the main symptoms of IBS.5 A significant advantage of peppermint oil is that it has been shown to be safe and effective in children. Another advantage may be that peppermint oil may reduce the intestinal levels of a fungus, Candida albicans, implicated by some in IBS.5
Robert’s formula is also known as Bastyr’s Formula and contains a number of different herbs designed to reduce inflammation and normalized both digestive and eliminative functions of the digestive system. While it has not been rigorously tested, it has been successfully used for IBS-D primarily by practicing naturopaths for about 50 years—more, if you know that Dr Bastyr based his formula on traditional treatments. Ingredients include Marshmallow (Althea officinalis) root, Wild Indigo (Baptisia tinctoria) root, Geranium (Geranium maculatum) root, Goldenseal (Hydrastis canadensis) root, Slippery Elm (Ulmus fulva) inner bark, Ginger (Zingiber officinale) root, Okra (Hibiscus esculentus) fruit, Niacinamide and Duodenum powder.
Padma Lax is a Tibetan formula that has been tested for IBS-D and has been shown to be effective.,  If the stools become too lose, lowering the dose is an effective approach. Padma Lax contains Aloe, Calumba Root, Cascara bark (Rhamnus purshiana), Condurango bark (Gonolobus condurango), Enulae Root (Inula helenium), Frangula Bark (Alder buckthorn), Gentian (Gentiana), Ginger, Kaolin clay, Myrobalan (Terminalia chebula), Nux Vomica (From the strychnine tree), Piper longum (Indian long pepper), and Rhubarb. Follow manufacturer’s instructions.
Many individuals with IBS have a variety of emotional issues to deal with. Some of these may have preceded the IBS and may have played a role in the development of IBS. Other issues may develop because of the difficulty in dealing with IBS, no matter what the type. There are a number of natural approaches to stress reduction such as deep breathing exercises, various relaxation techniques such as positive visualization and progressive muscle relaxation. In addition, cognitive behavioral therapy, yoga, tai chi, meditation, biofeedback, counseling, hypnosis and other approaches can be very beneficial. Anti-depressants and anti-anxiety medications are often used in people with IBS, sometimes for the benefit shown for IBS symptoms and sometimes to directly treat depression and anxiety. In natural approaches, the non-medication approaches are emphasized.
. Pizzorno, JE., Murray, MT, Joiner-Bey, H. The Clinician’s Handbook of Natural Medicine, Churchill Livingstone, 2003.
. Pizzorno, JE., Murray, MT. (eds) Textbook of Natural Medicine, 4th ed, Chap. 183, 2003.