Gastrointestinal health

DEFINITION: Complementary and alternative therapies considered for use in gastrointestinal health.

Overview

The gastrointestinal (GI) system includes the esophagus, stomach, intestines, colon, rectum, and anus. Many other organs assist in the digestive process of the GI system—the gallbladder, pancreas, and liver.

GI conditions are often chronic, can cause various degrees of discomfort, and can affect a person’s quality of life. In addition to an upset stomach, poor gut health may impact the skin, cause fatigue, or create autoimmune issues. Millions of people look to complementary and alternative medicine (CAM) as an adjunct to or a substitute for traditional medical therapy. While many CAM therapies do relieve symptoms, one should use them with caution because some therapies and dietary supplements can affect other modes of care and can lead to adverse reactions.

Surveys indicate that between 20 and 40 percent of Americans use CAM for GI care. Many persons with GI problems do not disclose their use of CAM to their doctor, which may also impact optimal care.

GI disorders may be functional—the system appears normal but does not “work” properly—or structural—the system includes swelling, obstruction, or other visual symptoms. Constipation and irritable bowel are common functional disorders, and hemorrhoids and cancer are examples of structural disorders.

Common CAM Therapies

The National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, categorizes CAM into four major categories: biologically based, manipulative and body-based, mind/body, and energy therapies. Other whole, ancient medical systems include traditional Chinese medicine, Ayurveda, homeopathic medicine, and naturopathic medicine.

Common Gastrointestinal Conditions

The most common GI health issues addressed by CAM include nausea and vomiting, dyspepsia, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), diarrhea and constipation, liver disease, and cancer.

Nausea and vomiting. Nausea and vomiting can be quite unsettling. They often arise in pregnancy, with an infection, or during medical treatment. Certain CAM therapies have been used for the relief of symptoms, including relaxation for chemotherapy-induced nausea and vomiting, and the herb ginger, the most commonly employed supplement to relieve nausea and vomiting. Some studies have demonstrated that ginger improves GI motility and acts as an antiemetic, which blocks serotonin receptors in the GI tract and in the central nervous system. Ginger also has been used with some success for morning sickness, motion sickness, chemotherapy, and postoperative nausea.

Acupuncture and acupressure have been shown to reduce symptoms of nausea and vomiting, and their use has been supported by much research on their effectiveness. Many hospitals have acupuncturists on staff.

Dyspepsia. Mild dyspepsia is often self-managed with CAM therapeutic agents, including bananas, red pepper, peppermint oil, caraway, ginger, apple cider vinegar, turmeric, and liquorice (Glycyrrhizaglaba). Most have shown efficacy over placebo in randomized-control trials and are common in the average home. Other lesser-known herbs also have shown promise. These include celandine, liu-jun-zi-tang, shenxiahewining, and STW 5.

Irritable bowel syndrome.Irritable bowel syndrome (IBS) affects between five and fifteen percent of Americans, mostly women. Many CAM therapies have been investigated to relieve discomfort. Bulking agents, such as psyllium, have been studied and prescribed the most. Psyllium, a first-line treatment for many, has been shown to speed up bowel movements. Allergic reactions to psyllium are possible but rare.

Many other CAM therapies have been used for IBS, including acupuncture, Ayurvedic medicine, Chinese herbal medicine, homeopathy, hypnotherapy, peppermint oil, probiotic therapy, and STW 5. Randomized-control trials have shown positive results for many of these therapies.

Diarrhea and constipation. Several herbal supplements are commonly used to improve colonic health. These supplements include aloe, apple pectin, cascara sagrada, chamomile, clove, echinacea, fennel, fenugreek, ginger, hibiscus, magnesium citrate, marshmallow, oat bran, Oregon grape, papaya, psyllium, raspberry, rhubarb, senna, spirulina, valerian, and yellow dock. Nearly all these herbs stimulate action and have a laxative effect. However, some herbs may interfere with other blood-thinning medications and should be discussed with a doctor before use.

Probiotics, good bacteria found in a healthy gut, are also used to prevent diarrhea and constipation. They are essential to overall gut health. Infection, the use of antibiotics, and even modern-day stress can lower healthy amounts of good bacteria in the gut. Antibiotics can disturb the balance of the gut’s ecosystem by killing friendly bacteria. The regular use of probiotics can generally improve the health of the GI system by stocking the gut with healthy bacteria and making less room for harmful bacteria and yeasts. Certain strains of Lactobacillus were shown to help restore colonic health after a course of antibiotics. L. casei Shirota and L. rhamnosus are helpful bacteria for treating chronic constipation. Also, a mixture of Bifidobacteria and Lactobacilli was shown to improve symptoms. In another study, a combination of B. lactis and B. longus showed promise for improving bowel regularity in persons in nursing homes. In a six-week double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, the use of a probiotic formula containing B. animalis significantly improved stool frequency.

Cultured dairy products, such as yogurt and kefir, are good sources of acidophilus and other probiotic bacteria. Fermented foods like sauerkraut also contain probiotics. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural food stores carry milk that contains live acidophilus.

In addition to probiotics, related substances known as prebiotics may enhance the colonization of healthy bacteria in the intestinal tract. Apples, garlic, bananas, asparagus, and onions are rich in prepiotics. It is important to note that many products sold on the market may not contain viable cultures at the time of purchase. A study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus. The situation has improved in subsequent evaluations, but some products still have no living organisms and, therefore, will provide no benefit. Some container labels guarantee the units of living organisms at the time of purchase, not just at the time of manufacture.

Other CAM therapies that have been used to treat IBS include biofeedback, abdominal massage, homeopathy, and colonic irrigation. Staying hydrated, getting enough sleep, and reducing sources of stress are also helpful. Some research has found that better-hydrated individuals tend to have less harmful bacteria in their gut linked to infections.

Mind/Body Therapies

The power of the mind to heal and bring about well-being has been demonstrated in self-reported quality-of-life measures. Strong evidence in the form of randomized-control trials is lacking, in part because of the difficulty in devising placebo/sham therapies and because of funding obstacles. Many practices, such as yoga, meditation, and Tai Chi, are said to help reduce abdominal symptoms and bring about a sense of relaxation.

Deep breathing and yoga are often used by people with IBS. Stress can exacerbate symptoms, so any practice that reduces stress and helps one cope with stress can reduce symptoms. Yoga focuses on a healthy spine for a healthy body and incorporates deep-breathing exercises. Different poses and movements involving twisting and balancing stimulate the nerves along the spine and promote circulation and energy flow.

Many professional athletes practice some form of yoga for increased flexibility. It is often incorporated into cross-training exercise routines. Some adolescents are embracing the mind/body forms of CAM. One study showed that adolescents between the ages of twelve and nineteen with IBS were likely to engage in or consider meditation, prayer, or both, for symptom management.

Energy Therapies

Acupuncture is commonly employed to reduce GI symptoms. While acupuncture may be helpful for some people and for certain conditions, the evidence for its effectiveness is unclear. Studies have shown no difference in acupuncture versus sham acupuncture. Several well-designed studies have shown both sham and treatment groups improving at the same rate. Modern science is still not clear how or if acupuncture works.

Chinese medicine has outlined hundreds of meridians, or channels, along the body that are thought to stimulate certain organs or systems. According to Chinese medicine, these channels conduct the flow of energy, or qi, a vital force that flows through the body. It is thought that blockages along the vital channels can result in pain or illness. Acupuncture is thought to remove blockages from the system and restore the normal circulation of qi. There is no scientific evidence, however, for the existence of the meridians or of qi. These channels have never been seen under a microscope or mapped, and they do not correspond to major nerve pathways.

Bibliography

Dix, Megan, and Erika Klein. "Signs of an Unhealthy Gut and What to Do About It." Healthline, 29 Jan. 2024, www.healthline.com/health/gut-health. Accessed 20 Sept. 2024.

Feldman, Mark, et al. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Saunders/Elsevier, 2021.

Micozzi, Marc S., et al. Fundamentals of Complementary Alternative and Integrative Medicine. 6th ed., Saunders/Elsevier, 2019.

National Center for Complementary and Alternative Medicine. "What Does NCCIH Do?", NCCIH, nccam.nih.gov. Accessed 25 Aug. 2023.