Irritable bowel syndrome (IBS) is a condition characterised by symptoms such as abdominal discomfort, bloating, wind and altered bowel habit. In conventional medicine, there is no real consensus on what causes IBS. IBS is what might be termed a diagnosis of exclusion. In other words, it’s the diagnosis that individuals end up with when tests have revealed there’s no conventional explanation for the symptoms (such as inflammatory bowel disease).
My experience in practice has led me to believe that IBS usually does have one or more specific underlying cause ” it’s just that these tend not to be tested for and/or recognised by conventional medicine. I find the top two causes of this condition are food sensitivity and an imbalance in the organisms that inhabit the gut. For more about this, see a previous blog post here.
Despite conventional medicine’s generally poor understanding of IBS, certain strategies do exist for its treatment. For example, some health professionals will advise that individuals with IBS increase their intake of fibre. In practice, I’ve found that this makes many patients worse. One potential explanation for this concerns wheat which is, in my experience, a common triggering factor in IBS. And when individuals are advised to consume more fibre, they almost inevitably opt for more in the way of high-fibre breakfast cereals and breads that are based on wheat.
Fibre as a treatment for IBS has been studied, and a review of the available evidence has been published in the British Medical Journal this week [1]. There are two main sorts of fibre that have been studied in this context: bran (usually from wheat) and ispaghula (derived from plaintain). Bran was not found to bring a statistically significant reduction in the risk of persistent IBS symptoms, though ispaghula (also known as psyllium) did. Ispaghula was found to reduce the risk of persistent symptoms by 22 per cent.
This review also looked at other strategies for IBS, including drugs that reduce spasm in the gut wall known as anti-spasmodics. 12 agents were assessed, of which only 5 brought statistically significant improvements in symptoms. Curiously, some drugs licensed for use for IBS (e.g. mebeverine) did not seem to have any good evidence for them. Only two agents (otilonoium and hyoscine) showed, according to the authors, consistent evidence of benefit. Of these two, the one with the best evidence appears to be hyoscine (Buscopan).
One final treatment assessed by the review was peppermint oil. This folksy remedy turned out to be better than placebo, reducing risk of persistent symptoms by more than half (57 per cent).
Another way the effectiveness of a treatment can be assessed is to measure the number needed to treat the number of individuals that need to be treated for one to get benefit. This review found the following NNTs for the treatments they assessed:
NNT for fibre: 11
NNT for antispasmodics: 5
NNT for peppermint oil: 2.5
Of these three main approaches for IBS, peppermint oil looks like the stand-out winner. My preference is still to attempt to elucidate the true underlying cause of someone’s IBS symptoms rather than merely treating the symptoms (see link above). That said, peppermint oil represents a generally safe and effective option for those looking for some symptomatic relief from IBS.
References:
1. Ford AC, et al. Effect of fibre, antispasmodics, and peppermint in the treatment of irritable bowel syndrome. BMJ 2008;337;a2313
I agree about looking for underlying causes rather than looking for drugs. In my experience causes can be : candida, parasites, wheat/dairy intolerance, other foods such as onions, coffee, tomatoes, but probably a mixture of these plus low beneficial bacteria.
Thank you for this write-up. Is the peppermint oil used topically or internally? Essential oil or infused? I have also found that enteric-coated peppermint oil capsules to be of great benefit as they make it all the way into the large intestine. Clients have stopped and/or cut in half their antispasmodics through these lovely little capsules, which have no side effects.
I had IBS years ago and it got steadily worse so I was spending hours laying on my bed in pain. Everyone said it was psychological, but as soon as I started taking Colpermin (peppermint oil capsule), it went away and never came back. I didn’t need to keep taking the Colpermin either. You can get it over the counter now. No doctors recommended it to me – I was just lucky enough to meet someone who knew about it. They are just peppermint oil in a capsule so that it dissolves lower down and it stops your bowel going into spasm.
Wanted to mention that pregnant women should use peppermint oil with extreme caution, especially early in pregnancy.
I have suffered from IBS since quite young and have found that too much ‘fibre’ of any sort will trigger a severe flare up; a tad problematic whilst trying to follow a healthy diet. Long ago, I discovered peppermint oil to be a most effective treatment in easing the pain, nausea & symptoms in general and always have high strength peppermint (gel) capsules in my fridge – just this week had to resort to using them. I also have Colofafac (Mebeverine hydrochlide) which definitely eases the inevitable diarrhoea.
When I have a flare up, I daren’t leave home without taking both remedies with me and would highly recommend them to anybody suffering this condition.
I thought onions and tomatoes had a very positive effect on the gut! Or any vegetables for that matter.
I was diagnosed with IBS a couple of years ago. The doctor’s anti spasmodics helped a bit. I heard on R4 about the use of Lacto Bacillus Plantorum and I’ve been taking that – I’m now so much better, with just the very occasional slight cramp. I’ve also been getting acupuncture, but that’s now down to a session every 3 months.
I now forget I ever suffered from it!
I have been laid up with a bowel spasm for past few days. My GP diagnosed it as such yesterday, but didn’t suggest any remedies apart from eating simple starchy foods and trying natural yoghurt. Last night, I tried the peppermint oil ( by eating half a pack of Polo mints ) and was feeling significantly better an hour later. I polished off another pack and half of mints during the night. This morning, I feel absolutely fine!!
I have ibs and had been to many doctors. It was only getting worse. I had tried everything, from stress reduction to probiotics, which only seemed to make it worse. Finally after a bad 3 weeks in which I had lost 10 pounds I bought some liquid peppermint and started to drink a strong dose twice a day. Within 3 days I was back to normal!! Now I drink one in the morning and one before bed, and I am ibs symptom free! ( my bowels haven’t been this healthy since I was a teenager!!!) I haven’t tried the enteric capsules yet, but I might soon, although a hot peppermint honey tea is extremely tasty!
I just started using peppermint oil 5 days ago. I read elsewhere that a person should give it 2 weeks use for marked improvement, but I’ve already noticed a significant decrease in cramping and that awful pain that literally makes my eyes water. (Have had IBS for over 20 years now.)
Now this morning I awoke not feeling right and lo and behold, it’s 7 bowel movements later and I’m pretty wiped out BUT unlike my typical episodes, (at least so far) there’s been no diarrhea or pain. So I took my morning peppermint oil tablet and will remain vigilant on this for a while. I am, in spite of this bout, feeling improvements. I have also been under tremendous stress as of late, which always triggers a “bout” for me (I think nerves are a huge factor in IBS). Thank you for the opportunity to share! Good luck everyone. I would give the peppermint a try if you suffer IBS.
I have been treated for IBS recently and have been put on Mebeverine, Apercap (peppermint oil) and Buscopan. I have had this for 4 years now and have got to the point that my ‘funny turns’ are happening alot and get to the point of such severe pain that i have anxiety attacks. Being on all this medication is helping but the discomfort in my bowels and stomach is awful. There is no pain but discomfort.
Hi,
I’ve had my IBS for over 20 years and only just got something that works,I’ve had stuff of the doctor in the past that has made it worse.
I now have Apercap and mebeverine although I rarely take the latter as one or 2 of the Apercap are brilliant make it almost go away completely.20 odd years of 24/7 pain feels strange now it not being there but so much more energy and happier,I didn’t realize the effect it was having psychologically on me.
So Apercap works for me,great.Good job last doc I saw,not so good the 20 or so before.