“The first wealth is health.” - Ralph Waldo Emerson

Natural remedies for IBS. Are natural remedies any good for IBS? And are they safe?

With the mountain of treatment options available, and millions of people struggling to control their symptoms it's no wonder so many people turn to natural remedies in search of relief. Perhaps you have too?

I think another couple of reasons why people turn to alternative options, like natural remedies is because many people don't like taking medications or their potential side effects, so "natural" seems like an obvious alternative?

Another possible reason is to do with the fact that currently there's no definitive test to diagnose IBS.

Instead, it's based around meeting specific criteria and doctors checking you to make sure you've not got anything else going on (1,2,3,4). If you've been diagnosed with IBS, you'll know where I'm coming from because you'll have been through this process.

And this lack of diagnostic test for IBS can create uncertainty around the diagnosis (5), leading people to (unnecessarily) keep going to get more and more tests done, and/or turning to alternative and complimentary therapies, including herbal remedies and homeopathy.

👉 So, it's important to question the SAFETY and EFFECTIVENESS of these remedies to avoid risking your health, and wasting your money and time.

❗️ By the way, if you haven't got a diagnosis for your symptoms, it's essential for both your health and peace of mind, to go get checked out.

What are "natural remedies"?

There are loads of different types of remedies widely available (6). And include things like herbal remedies, essential oils, homeopathy, traditional Chinese medicine, Ayurveda, naturopathy, traditional indigenous remedies, and nutritional supplements. These remedies use plants, extracts, oils, and other natural substances (6).

The Challenge of Evaluating Natural Remedies

When it comes to natural remedies for IBS, the wealth of information available online can be overwhelming.

A simple Google search for "natural remedies for IBS" gets nearly 4.2 million results. Although we all know this, it's crucial to approach these findings with caution and scepticism!

When you're hunting around for help with your IBS, you can come across tons of people sharing their positive personal experiences, but it's important to realise that these anecdotes should not be confused with reliable scientific evidence.

💥 Here's a few key points to bear in mind...

1. Lack Of Standardised Formulations:

Natural remedies can vary widely in their composition and potency (7). Unlike pharmaceutical drugs with precise dosages and standardised formulations, natural remedies can lack consistency.

This means it's difficult to guarantee that the same amount of the active ingredient(s) will be given to each person in a study in a set amount of the product. And because of this, it makes it challenging to compare different products or replicate results across studies.

In research, it's important to have precise and consistent dosing to accurately evaluate the effectiveness of a treatment (8). Without standardised dosages, it's difficult to have uniformity and get accurate results.

👉 In practical terms, you could buy two "identical" products, but their potency and composition, which includes both active and potentially toxic ingredients, could vary between being slightly to significantly different.

2. Limited Scientific Evidence:

According to Hassan et al. (2022) there are over 20,000 herbal products available in the US, but many of them don't have enough evidence to prove their effectiveness (9).

Pharmaceutical drugs (thankfully) go through extensive testing and clinical trials to ensure their effectiveness and safety (10).

❗️However, natural remedies don't undergo the same level of scientific scrutiny. This makes it challenging to determine how well they work and IF they are safe.

Also, natural remedies aren't regulated like pharmaceutical drugs (11), so the quality (and composition, as I've just mentioned) can significantly vary. This makes it difficult to accurately assess and control the factors in a research study.

When the product quality is inconsistent, the results of the study will be unreliable and misleading.

And what does this mean for you, if you're considering using these products?

You need to be careful! And seek advice from a qualified health professional.

3. Contamination Risks:

Another issue is the risk of contamination.

Natural remedies are often made from plants, herbs, or other natural substances, which can be contaminated with pesticides, heavy metals, or other harmful substances (7,12).

These contaminants can pose health risks (12)... on top of the potential risk associated with the active ingredient.

Expert Recommendations

Respected medical organisations around the world have provided guidance based on the available evidence.

For example, the UK's National Institute for Health and Care Excellence (NICE) discourages the use of aloe vera, acupuncture, and reflexology for IBS treatment (3).

Similarly, the Canadian Association of Gastroenterology advises AGAINST offering herbal remedies and acupuncture to improve IBS symptoms (1). These recommendations emphasise the lack of scientific evidence supporting the effectiveness of these natural remedies for IBS (1).

The American College of Gastroenterology (ACG) IBS guidelines mention the use of peppermint, but they highlight the low quality of available evidence (2). This means that the recommendation for using peppermint oil is NOT very strong or conclusive.

And the ACG states:

"... only a small number of commercially available peppermint oil supplements have undergone rigorous testing of efficacy and safety" (2).

The ACG recommends further large, carefully designed studies to find out the best formulation of peppermint, how it might help in different IBS subgroups like IBS-diarrhoea predominant and IBS-constipation predominant, and compare their effectiveness with other treatments (2).

The British Society of Gastroenterology (BSG) also mentions that peppermint oil may be helpful for IBS symptoms, and they too highlight that the quality of evidence is very low (4).

Clinical guidelines focus on evidence-based recommendations that are supported by a robust body of research.

As I've mentioned above, natural remedies face challenges such as variability, lack of standardisation, and limited rigorous clinical trials.

And because of this, various guidelines may not provide specific recommendations for natural remedies due to the lack of sufficient high-quality evidence supporting their use.

Regulation and Quality Control

Because there are lots of different types of remedies and regulations vary by country, buying products from different parts of the world can increase the risk of potential harm, as their safety and oversight can differ.

There's widespread belief that natural products are inherently harmless (9,13), leading people to use them without considering the potential consequences, especially when using them alongside prescription or over-the-counter medications.

👉 And unfortunately, side effects and adverse events from natural remedies often go unreported, which means it doesn't get officially logged and investigated... making it harder to put safety measures in place.

❗️ Possible side effects of herbal remedies can range from mild to severe complications, including headaches, gut symptoms, damage to internal organs or death (9).

Individual Variability

Another critical factor to consider is the fact that everyone is different.

What may work for one person may not necessarily work for another.

And what is safe for one person, may not be safe for another.

So it's crucial to recognise that people can respond differently to natural remedies due to their unique physiology and health conditions.

While some people may find relief from specific natural remedies, others may experience no benefit or even adverse effects.

This variation in response further complicates the evaluation of natural remedies for IBS and underscores the importance of personalised healthcare approaches (3).

Key Points:

Interest in natural remedies for IBS remains high, but there are several important things to consider before trying them.

1. Evaluate available evidence and seek expert recommendations.

2. Be aware of challenges like inconsistent product formulations and limited scientific support.

3. Approach natural remedies with caution due to these challenges.

4. Consult a qualified healthcare professional for personalised guidance, before using alternative remedies and treatments, especially if you have any health conditions or are taking any medications (prescription or over-the-counter) (8).

If you want to prove or disprove natural remedies by looking online, then you’ll find what you’re looking for.

But if you want to take an open and unbiased look then you’ll check out all the best evidence available and see what that says. And even then, that still doesn’t mean it’ll work for you! ... or be suitable for you.

And remember, “natural” doesn’t mean it’s safe.

References and some other interesting articles

1. Moayyedi, P., Andrews, C. N., MacQueen, G., Korownyk, C., Marsiglio, M., Graff, L., ... & Vanner, S. (2019). Canadian Association of Gastroenterology clinical practice guideline for the management of irritable bowel syndrome (IBS). Journal of the Canadian Association of Gastroenterology, 2(1), 6-29.

2. Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG clinical guideline: Management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG, 116(1), 17-44.

3. Irritable bowel syndrome in adults: Diagnosis and management. NICE Clinical guideline [CG61] Published: 23 February 2008 Last updated: 04 April 2017

4. Vasant, D. H., Paine, P. A., Black, C. J., Houghton, L. A., Everitt, H. A., Corsetti, M., ... & Ford, A. C. (2021). British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut, 70(7), 1214-1240.

5. Linedale, E. C., & Andrews, J. M. (2017). Diagnosis and management of irritable bowel syndrome: A guide for the generalist. Medical Journal of Australia, 207(7), 309-315.

6. Wasiullah, M., Yadav, P., & Rai, A. (2022). Complimentary and alternative medicine for treatment of IBS. World Journal of Pharmaceutical Research, 12(1), 1049-1056.

7. Ichim, M. C., & Booker, A. (2021). Chemical authentication of botanical ingredients: A review of commercial herbal products. Frontiers in pharmacology, 12, 666850.

8. National Research Council. (2010). The prevention and treatment of missing data in clinical trials. Panel on Handling Missing Data in Clinical Trials. Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

9. Hassen, G., Belete, G., Carrera, K. G., Iriowen, R. O., Araya, H., Alemu, T., ... & Jain, N. (2022). Clinical implications of herbal supplements in conventional medical practice: A US perspective. Cureus, 14(7).

10. BMJ (2023). The British Medical Journal research methods and reporting.

11. Thakkar, S., Anklam, E., Xu, A., Ulberth, F., Li, J., Li, B., ... & Tong, W. (2020). Regulatory landscape of dietary supplements and herbal medicines from a global perspective. Regulatory Toxicology and Pharmacology, 114, 104647.

12. Quan, N. V., Dang Xuan, T., & Teschke, R. (2020). Potential hepatotoxins found in herbal medicinal products: A systematic review. International journal of molecular sciences, 21(14), 5011.

13. WHO. (2004). WHO guidelines on safety monitoring of herbal medicines in pharmacovigilance systems.

EMA. (2017). Guideline on the assessment of clinical safety and efficacy in the preparation of EU herbal monographs for well established and traditional herbal medicinal products.

Parvez MK, Rishi V. Herb-Drug Interactions and Hepatotoxicity. Curr Drug Metab. 2019;20(4):275-282. doi: 10.2174/1389200220666190325141422. PMID: 30914020.

Arora, G., Arora, A., Chaudary, V., Kamlija, M., & Kamlija, H. (2020). Possible herbal-drug interactions: An evidenced base review. Altern Ther Health Med.

14. Hatami, K., Kazemi-Motlagh, A. H., Ajdarkosh, H., Zargaran, A., Karimi, M., Shamshiri, A. R., & Ghadir, M. R. (2020). Comparing the Efficacy of Cumin Sofouf With Mebeverine on Irritable Bowel Syndrome Severity and Quality of Life: A Double-blind Randomised Clinical Trial. Crescent. J. Med. Biol. Sci, 7, 186-194.

15. Peckham EJ, Cooper K, Roberts ER, Agrawal A, Brabyn S, Tew G. Homeopathy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2019 Sep 4;9(9):CD009710.

16. Ghoshal, U. C., Sachdeva, S., Pratap, N., Karyampudi, A., Mustafa, U., Abraham, P., ... & Venkataraman, J. (2023). Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian eurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology. Indian Journal of Gastroenterology, 1-25.

17. Gwee, K. A., Gonlachanvit, S., Ghoshal, U. C., Chua, A. S., Miwa, H., Wu, J., ... & Hongo, M. (2019). Second Asian consensus on irritable bowel syndrome. Journal of neurogastroenterology and motility, 25(3), 343.

18. Larussa, T., Rossi, M., Suraci, E., Marasco, R., Imeneo, M., Abenavoli, L., & Luzza, F. (2019). Use of complementary and alternative medicine by patients with irritable bowel syndrome according to the Roma IV criteria: a Single-Center Italian Survey. Medicina, 55(2), 46.