Irritable Bowel Syndrome is tricky. Basically, you show up at the doctor’s office with lower GI symptoms – alternating constipation and/or diarrhea, gas and bloating perhaps, maybe bowel pain and cramping that goes away when you have a bowel movement – and when the doctor can’t diagnose anything else wrong with you, it gets called IBS.

IBS is a not a structural disorder, but a functional one. Nothing needs to be physically wrong with your colon – nothing eroded or inflamed – it’s just acting wrong. All of which makes IBS hard, not just to diagnose, but to treat, since there’s nothing to actually heal. IBS is hard to treat, too, because the symptoms can be erratic. There’s IBS-D (diarrheapredominant), IBS-C (constipation-predominant), and IBS-M (mixed). But the lines are blurry, and most people will experience some back-and-forth.

AND – having said all that, there are ways to manage IBS (a few follow).

Comorbidities is a medical term which means “other conditions or diseases you have at the same time.” Watch for comorbidities, and try and address them. For example, IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) are entirely different. But… one may be exacerbating the other. Ditto for reflux and other stomach acid issues. Ditto for food allergies and lactose intolerance. Ditto even for anxiety and depression. Read on!

Diet: Some people find it helps to avoid foods which make them gassy. Others find they need to stay off dairy, or wheat. Still others find that small meals are key. Some people find raw vegetables are a real killer. And of course there are people for whom food choice doesn’t seem to make a difference at all. Remember, just experiment.

Stress reduction: One theory says that IBS isn’t really a problem with the gut at all, but a problem with the brain. The gut is simply responding to stress, depression, and anxiety that originate elsewhere. (This wouldn’t make it “all in your head,” of course, any more than high blood pressure caused or exacerbated by stress is “all in your head.”)

It’s still controversial whether mood actually causes IBS, or just makes it worse. What isn’t controversial, however, is that stress reduction makes it better. There’s been a fair amount of research here, and it’s been largely consistent: find a way to handle stress better, and your IBS gets better. It doesn’t matter whether we’re talking yoga, meditation, mindfulness training, even hypnosis, or cognitive-behavioral therapy delivered over the internet (all of which have been researched in solid clinical trials). I’ll repeat: find a way to handle stress, and your IBS gets better.

Peppermint Oil relaxes spasming smooth muscle on contact, including muscles spasming along the gut. It’s really as simple as that. The peppermint oil touches your gut muscles, and they calm down. It’s that simple. To be clear, you’re not trying to absorb the peppermint into your system, or metabolize it. You just want it to touch your gut walls.

The problem is, peppermint oil doesn’t discriminate. It touches a smooth muscle, that muscle gets relaxed. Guess what else is a muscle? The lower esophageal sphincter is. You know, the valve at the top of the stomach that holds the acid in. So… a lot of peppermint can make reflux worse. You can get around that by using peppermint oil capsules that are enteric-coated, i.e. set up to dissolve in the intestines, not in the stomach. That’s what we suggest, and what we sell here. The standard dose is 0.2-1 ml daily, in divided doses. Give it a day or two.

Red (Hot) Pepper: In one very small trial, taking hot red pepper regularly greatly reduced gut pain in IBS – if not necessarily other symptoms. It’s spicy (obviously), so use with caution.

Probiotic Bacteria. There are bacteria inside all of us. Each of us hosts an average 100,000,000,000,000 (pronounced “one hundred quintillion”) live bacteria, the vast majority in the gut. Considering that each of us is composed of roughly just 10,000,000,000,000 human cells, you could say bacteria outnumber us 10 to 1 – in our own bodies!

A healthy gut, with an intact gut lining, maintains conditions which promote the growth of “friendly” commensal bacteria. These friendly bacteria in turn help stabilize the gut. It’s very much a symbiotic relationship. (And it extends far past the gut: friendly bacteria regulate our immune systems. They help digest food, and assist in detoxification. They displace other, less “friendly” species. They likely reduce the risk of cancer and liver disease).

Microbial populations in the gut are constantly shifting. Eat lots of dairy? Dairy-digesting bacteria thrive. Eat lots of fiber? Bacteria that process fiber rise. Eat lots of sugar, and yeast species like candida get a leg up. Take antibiotics that decimate bacterial flora, and the yeasts have nothing to hold them back. Let inflammation take hold, and the ensuing erosion of the gut makes it harder for healthy bacteria to hold on. These shifts don’t happen overnight. Corrections won’t happen overnight, either

Which brings us to the research… There’s been an awful lot of it. Much of it has been quite positive. But it’s hard to generalize. since most research focuses on a single probiotic strain. It appears that yeast probiotics, in particular Saccharomyces boulardii, may have the most to offer in IBS-D. IBS-C may respond best to bifidobacteria probiotics. Which makes sense: bifidobacteria tend to colonize the large intestine. Some of the best research on IBS-M has focused on Bacillus coagulans.

AND – having said all that, I’m going to suggest a different path. Don’t just try and pick the “best” strain. Get your hands on broad-spectrum probiotic, with diverse strains of Lactobacilli and Bifidobacteria. Shoot for a dose of 30 billion live cells, minimum (up to 200 billion), daily. A broadspectrum probiotic can colonize all the ecologic niches in the gut, so we’re talking side benefits beyond IBS: immune health, detoxification, digestion, etc. Try it, and see what happens. People often see benefits in a week for diarrhea. It may take two months for the benefits to show in constipation. AND – if doesn’t work, then look for a specialized product.

Fiber has a normalizing effect on bowel movements, since it can firm up loose stools, and help ease stubborn ones along. That being said, some sources of fiber (insoluble fiber) can be rough and abrasive (sort of “scratchy”) to a sensitive gut. These include wheat bran, psyllium, and raw vegetables. On the other hand, soluble fibers (the kind that fully dissolve in water) are usually a safe bet. So think gums and pectins, most fruit, oatmeal, and chia seeds.

Some fibers are also classifiable as “prebiotics,” which is to say they feed the probiotic bacteria in our gut. Of these, Acacia fiber from the Acacia tree stands out as a great supplement for IBS. It’s soluble, prebiotic, relatively inexpensive, and easy to take. It makes a difference for people.

Melatonin: this natural sleep hormone is just about the cheapest thing in the health food store, and it does so much! Yes, it can help you sleep. But it also nudges your body into a rest-and-repair state. We see some real benefits with immunity when people take it. We see some real benefits to the digestive system as well. For example, improvements to reflux, and to IBS. Try taking 2-3 mg at night for a few weeks, and see what happens.

General Digestive Tonics are often helpful. Herbs like ginger and chamomile (which soothe digestion). Herbs like fennel, caraway, and cumin (which dispel gas). We’ve got a few products worth looking at. In particular, the Intestinal Calmpound from Herbalist & Alchemist combines some of these, plus some mild antispasmodics.