Managing Irritable Bowel Syndrome: Nutrition Supplements, Psychological and Physical Approaches

Irritable Bowel Syndrome (IBS) is the most commonly diagnosed gastrointestinal (GI) condition. Symptoms include repeated abdominal pain with changes in bowel movements (diarrhea, constipation, or both). IBS is a disorder of how the brain and gut work together. 

In the United States, IBS is more common in women than men, and people younger than age 50 are more likely to develop IBS than people older than age 50. About 12 percent of people in the United States have IBS.

IBS was once called by different names, such as colitis or spastic colon, but doctors now refer to three types: IBS with constipation, IBS with diarrhea, or IBS with mixed bowel habits. Many people with IBS have normal bowel movements on some days and abnormal bowel movements on other days.

TL;DR

Nutritional Approaches

  • There is some evidence that peppermint oil may help reduce irritable bowel syndrome (IBS) symptoms.
  • Although some evidence suggests that certain probiotics may improve IBS symptoms, there is not enough evidence to know for sure.
  • Research on prebiotics has not found clear benefits for people with IBS.
  • Except for peppermint oil, the evidence on herbal products is too limited for any conclusions to be reached.

Psychological and Physical Approaches

  • There is some evidence that gut-directed hypnotherapy can help with IBS symptoms and improve health-related quality of life.
  • The research on acupuncture for IBS is not conclusive.
  • There is very little research on meditation and mindfulness, yoga, or relaxation techniques for IBS.

Safety of These Approaches

  • Probiotics and peppermint oil have a history of apparently safe use, but both can have side effects. Also, few studies have looked at the safety of probiotics in detail, so there’s a lack of solid information on the frequency and severity of side effects.
  • Prebiotics have a long history of safe use. However, taken in large doses (more than 20 grams per day for an adult), they can have side effects including gassiness, bloating, abdominal pain, cramps, and diarrhea.
  • Psychological and/or physical approaches generally have good safety records when used correctly. However, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches.

Complementary Health Approaches

Complementary health approaches are a group of diverse medical and health care systems, practices, and products whose origins come from outside of mainstream medicine. They include such products and practices as herbal supplements, other dietary supplements, meditation, spinal manipulation, and acupuncture.

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

  • Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, microbial-based therapies)
  • Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies)
  • Physical (e.g., acupuncture, massage, spinal manipulation)
  • Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating)

Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

Nutritional Approaches

Peppermint Oil

There is some evidence that enteric-coated peppermint oil capsules can help reduce IBS symptoms over the short term. There is not yet enough evidence to know if peppermint oil helps long term.

  • A 2020 review and analysis of 11 studies in 684 people reported that peppermint oil is a safe and effective treatment for global IBS symptoms over the short term.
  • A 2021 study that gave 133 people with IBS either enteric-coated peppermint oil pills or placebo (fake) pills for 6 weeks reported that IBS symptoms improved the same amount in both groups. More people in the peppermint oil group reported side effects, but none were serious.
  • Clinical practice guidelines published in 2021 by the American College of Gastroenterology, the professional organization for doctors who treat digestive disorders, include peppermint oil as one of several approaches that may be helpful for relieving IBS symptoms. However, this recommendation is based on low-quality evidence.
  • Side effects from peppermint oil are usually mild and may include reflux, heartburn (especially if the pills are not enteric coated), belching, and perianal burning.
  • Peppermint oil shouldn’t be taken by people with a hernia or gastroesophageal reflux disease (GERD), especially at high doses.

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Herbal Products

Probiotics

Prebiotics

Psychological and Physical Approaches 

Gut-Directed Hypnotherapy (Hypnosis)

In hypnosis, practitioners help lead people into a state where they are open to suggestion. In gut-directed hypnotherapy, practitioners make suggestions aimed at allowing people to control their GI functions.

There is some evidence that gut-directed hypnotherapy can help people who have IBS with GI symptoms, anxiety, depression, disability, and health-related quality of life. Research has also reported that gut-directed hypnotherapy can help relieve GI pain in children with IBS.

  • Practice guidelines issued in 2021 by the American College of Gastroenterology recommend gut-directed psychotherapies including gut-directed hypnotherapy for treating IBS symptoms. This recommendation is conditional, however, based on very low-quality evidence.
  • A 2020 review and analysis of 41 studies in 4,072 people found that gut-directed hypnotherapy helped improve IBS symptoms or pain more than education in adults with IBS. However, it did not help more than other psychological therapies, such as cognitive behavioral therapy or stress management, which worked about as well. In people with refractory IBS symptoms (symptoms that are ongoing and do not respond to conventional treatments), cognitive behavioral therapy and gut-directed hypnotherapy helped the most over the long term.
  • A 2017 review of 4 studies in 146 children and adolescents with recurrent abdominal pain and functional abdominal pain disorders including IBS reported that hypnotherapy and guided imagery may reduce pain frequency and intensity in this age group in the short term, based on low-quality evidence.
  • The use of hypnosis in the treatment of medical conditions has a good safety record. However, it’s possible that hypnosis could worsen symptoms in people with some mental health conditions.

Yoga

Meditation and Mindfulness

Relaxation Techniques

Acupuncture

More Information

More To Consider

  • If you have IBS, you may have to try a few treatments—lifestyle changes, medicines, probiotics, mental health therapies—to see what works best for you. See what your health care provider recommends.
  • If you’re considering a practitioner-provided complementary health practice such as hypnotherapy or acupuncture, ask a trusted source (such as the health care provider who treats your IBS or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you’re considering. NCCIH’s website offers some tips on how to find a complementary health practitioner.
  • Keep in mind that some dietary supplements can interact with medications or other dietary supplements. They also may contain ingredients not listed on the label. Your health care provider can advise you about potential interactions. If you’re pregnant or nursing a child, or if you’re considering using a dietary supplement for a child, it’s especially important to consult your (or the child’s) health care provider.
  • Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

Trusted Website U.S. National Center for Complementary and Integrative Health Open the link →

Derek Yang

I'm an immigrant living with my family in a small town on the East Coast. I love classical music, enjoy a good cup of coffee, and have a soft spot for BMWs. I believe in lifelong learning and look forward to connecting with you to share our life experiences. Twitter @mrderekyang.

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