Patients With GI Issues? Natural Remedies May Give Relief

Almost two thirds of Americans are burdened by gastrointestinal (GI) symptoms like heartburn, abdominal pain, bloating, diarrhea, and constipation. And for almost 40% of Americans, uncomfortable bowel symptoms are bad enough that they forgo routine activities such as exercising or spending time with their families.

Medications, both over the counter and prescription, targeting GI conditions are plentiful. Yet more and more patients are requesting natural routes to relief, doctors told Medscape Medical News, and it’s likely your patients are, too.

Here are some examples from doctors on how they’ve integrated natural remedies into their practice for specific common complaints. Some remedies have published research to back them up, while others are anecdotal, but backed by patients and doctors reporting that they do work.

Irritable Bowel Syndrome (IBS)

For patients with IBS, Priyanka Hennis, MD, MS, family medicine physician in Phoenix, prescribes a diet low in fermentable oligosaccharides, disaccharide, monosaccharide, and polyols (FODMAP).

The American Gastroenterological Association also recommends dietary and lifestyle modification first, including a low-FODMAP diet. The American College of Gastroenterology provides further details on what a low-FODMAP diet is, how it works, and examples of high- and low-FODMAP foods. Wheat, apples, and milk are high in FODMAPS, for instance; oatmeal, broccoli, and eggs are low. A low-FODMAP diet reduces certain difficulties in digesting carbohydrates.

In one study comparing a low-FODMAP diet plus traditional IBS dietary advice, a low-carbohydrate diet with high in protein and fat, and medical treatment based on the predominant symptom, researchers found that more patients in the dietary intervention groups improved. Seventy-six percentage of patients in the low-FODMAP group reduced their IBS symptoms severity score by 50 points or more, as did 71% of those in the low-carbohydrate group, but just 58% of the medication group did so. “Dietary interventions might be considered as an initial treatment for patients with IBS,” the researchers concluded.

And if your patient equates IBS with irritable bowel disease, that’s a common myth that’s ripe for debunking, and it’s easy to explain the difference, said Omar S. Khokhar, MD, board-certified gastroenterologist at OSF Healthcare, St. Joseph Medical Center, Bloomington, Illinois. “IBS by definition is a syndrome, a constellation of symptoms, for which we can’t find an organic pathology. IBD [inflammatory bowel disease] is a completely different phenomenon, where there is active inflammation inside your GI tract, causing symptoms, and physiological changes.”

The disruption of the gut microbiota, or dysbiosis, is thought to play a role in IBS, Khokhar said, and recent research agreed. The goal to provide relief is restoring the microbiota by such measures as dietary changes.

For patients with constipation-predominant IBS, Hennis also recommended slow, deep breathing to improve symptoms. In one study comparing patients who conducted deep breathing exercises and control individuals, the intervention group had improved symptoms, with a higher desire to defecate, improvements in stool consistency, and in weekly bowel movement frequencies.

Constipation

While psyllium and prunes are old standbys for chronic constipation, kiwifruit also has some solid research behind it. Researchers randomly assigned 75 people with chronic constipation to eat either two green kiwifruits, 100 g of prunes, or 12 g of psyllium each day for 4 weeks. Improvements in bowel movement frequency were similar for all three groups, but stool consistency improved more with the kiwi and the prunes. Those in the kiwi group had improvement in bloating. People also preferred the kiwi treatment.

Try a constipation smoothie, suggested Erin Toto, MD, assistant professor of gastroenterology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia. The recipe is from the University of Michigan Bowel Control Program and has fresh fruit, kefir, and ice.

The age-old advice to increase fiber still holds, said Cynthia Odogwu, MD, family medicine physician in Bowie, Maryland. The Dietary Guidelines for Americans recommend fiber intakes based on age and sex and offer a chart of fiber content of common foods. Odogwu suggested 25-35 g a day for adults.

It’s crucial to drink water with fiber, Khokhar said. Along with taking in 30 g of fiber daily, he tells patients to drink 64 oz of water.

Gastroesophageal Reflux Disease (GERD)

For GERD, try aloe vera, said Chrissie Ott, MD, an integrative pediatrician and internal medicine physician in Portland, Oregon. In a study, Chinese researchers reported that aloe vera syrup was safe and effective, and it reduced the frequencies of eight main GERD symptoms: heartburn, food regurgitation, flatulence, belching, dysphagia, nausea, vomiting, and acid regurgitation.

“And if there is inflammation in the gut, it’s an easy way to soothe things quickly,” Ott said.

Apple cider vinegar is another GERD remedy, Khokhar said. He advised about a tablespoon mixed with 8 oz of water. “Drink it anytime during the day.”

Lifestyle adjustments — including weight loss if needed, raising the head of the bed and reducing intake of caffeine and alcohol — can greatly reduce GERD symptoms, experts concurred. Khokhar tells patients that many GI maladies are also a result of diet and warns against such practices as eating a huge plate of pasta before bedtime.

Excess Gas

Fermented foods, such as sauerkraut and apple cider vinegar, can significantly impact the microbiome and can help patients with excess gas and small intestinal bacterial overgrowth, Ott said. Published research backs her up on the impact of fermented foods on the microbiome, with researchers finding fermented foods “should be considered an important element of the human diet.”

She suggests her patients with excess gas to try her nonalcoholic “cocktail” — a mix of 1 tablespoon of apple cider vinegar, flavored or unflavored bubbly water, and a slice of lemon. Another option is to spoon a few tablespoons of sauerkraut on the side of a dish.

Khokhar reminds patients: “Gas is a normal, healthy byproduct of the digestive process.” But if it becomes an issue for them, he advises taking stock of whether they are eating high amounts of foods known to produce gas, such as beans, cabbage, broccoli, yogurt, and sugary drinks.

Nausea and Vomiting

For nausea and vomiting, try ginger, said Troy Alexander-El, MD, a primary care physician in Portland, Oregon. While some researchers conclude it is a safe botanical option, they also note that the quality of published evidence should be increased.

Alexander-El said she adds ginger to dishes while cooking. She buys ginger slices or ginger cubes in the frozen food section and adds a cube when cooking dishes like broccoli. “It can also help with gas.”

Diarrhea

Peppermint oil can help the diarrhea and the cramping that often accompanies it, Khokhar said. He suggested taking one or two capsules of over-the-counter peppermint oil one to three times a day.

Research is mixed, with some research finding it helped improve IBS symptoms (such as diarrhea) but not significantly better than placebo. A meta-analysis found it effective for adults with IBS symptoms, but researchers called for more research.

Gut Shy?

While GI issues are common, patients are often reluctant to broach the subject with their physicians. The American Gastroenterological Association found people with GI issues would rather discuss politics or reveal their weight than talk about GI distress with their doctors. To turn that reluctance around, the society launched its “Trust Your Gut” campaign to help people open up and get help.

Alexander-El, Hennis, Odogwu, Khokhar, Toto, and Ott reported having no disclosures.