The symptoms for irritable bowel syndrome, or IBS, can range from mildly annoying to severely life-altering. And according to Justin Brandler, M.D., a gastroenterology fellow at Michigan Medicine, the disease truly is a spectrum.

"From mapping out every bathroom location on your travel itinerary, to hiding your diarrhea and incapacitating abdominal cramping from your colleagues, IBS can include many different things," says Brandler. "As the pandemic continues, many patients with IBS have experienced improved symptoms as they stay closer to home. However, others have had to deal with a significant worsening of symptoms due to unexpected uncertainties, like job loss, disrupted child care and social isolation."

Brandler adds that this range in symptoms and severity can be especially challenging for both providers and patients, even outside of a pandemic. But as a physician, he finds this diversity both challenging and rewarding.

"In order to properly care for patients with IBS, a healthy blend of art and science is required, as well as a partnership with our patients to develop evidence-based and personalized treatment plans that revolve around a trusting clinician-patient relationship," he says.

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And because the tools for "beating the battle of the bowels" can be so diverse, Brandler weighed in on several treatment options to best empower individuals with IBS to use medical data when deciding on their care.

Here's what he had to say:

Natural and herbal supplements

The majority of natural and herbal medications have not been studied in depth, so it's difficult to strongly recommend them, especially given their cost and potential side effects. However, some have been more studied than others and most studies involve patients with mild to moderate symptoms.

The popularity in desire for natural and herbal remedies has grown among young people, which has led to more studies to better provide evidence-based recommendations to patients. This popularity can be described as a double-edged sword because it has led to many companies marketing products with significant variability between brands and preparations.

If you're interested in natural and herbal supplements for IBS, make sure to check with your provider before starting this alternative therapy.

Prebiotics and probiotics

"Prebiotics" are nutrients for bacteria and can be described as the building blocks for nurturing a healthy and diverse gut bacteria environment.

Currently, prebiotics can be defined as high-fiber foods or fiber supplements, although more definitive formulations will likely be developed in the future.

"Probiotics" are bacteria themselves and are not currently recommended for IBS outside of research studies. Most probiotics on the market have variable amounts (and types) of bacterial strains, which makes it difficult to prescribe a specific type for someone with IBS.

The most studied strains of bacteria in IBS are Lactobacillus and Bifidobacterium, and many brand names contain them.

As a significant amount of research within this field is currently underway, gastroenterologists might be able to more confidently recommend prebiotics and probiotics in the future.  

Cannabis

When it comes to cannabis, almost no commercial preparations are created equal, which makes it very hard to recommend. The term cannabis can be described as tetrahydrocannabinol, or THC, combined with cannabidiol, or CBD.

There are THC receptors in your gut and your brain, which can lead to feelings of euphoria when triggered. As for CBD, there are receptors in your gut, but not in your brain.

While often used to help with nausea, cannabis can also have the opposite effect and lead to significant problems with uncontrolled vomiting. However, there have been promising clinical studies that show cannabis alleviates abdominal pain.

And just like prebiotics and probiotics, more studies about harnessing the potential benefits of cannabis are on their way.

Low FODMAP and gluten free diets

Roughly 50% of patients with IBS show significant symptom relief when adhering to a low FODMAP diet. However, the power of this diet can be harnessed even further when a patient is guided by a dietitian trained in this specific diet.

It's important to remember that while this eating plan involves changes to nutrition and lifestyle, this is not a "forever diet." It is comprised of three specific phases, with the first restrictive phase lasting for two to six weeks. During this period, patients can assess whether or not their bodies are responding to the diet in a positive way.

Following a gluten-free diet is important for patients with celiac disease, but many other individuals without the disease can also have GI (and non-GI) symptoms related to gluten.

However, it's important to acknowledge that some of these symptoms may not actually stem directly from gluten, but instead, from components of wheat or fructans (which are a part of the low FODMAP diet.)

If an individual has a desire to start dietary therapy, they should discuss the options with their health care provider, especially given the risks for nutrient deficiencies on restrictive diets.

GI behavioral health

This form of therapy is currently the most effective non-medication option for treating IBS. GI behavioral health addresses the dysregulated brain-gut connection. The brain acts as an amplifier to control the sound, while the gut serves as the speakers.

The goal of this type of therapy is to learn lifelong tools to help turn down the volume to your GI tract, which is often set at too high of a volume, leading to symptoms.

Some examples of GI behavioral health include cognitive behavioral therapy, gut-directed hypnotherapy (or visualization) and meditation.

Effective over-the-counter and prescription treatments for IBS

When it comes to OTC and prescriptions treatments, the overall takeaway is that there are a lot of different (and effective) options, with many more to come. This means that there is hope for patients who have suffered with symptoms for decades.

One of the biggest misconceptions about these drugs is that when providers recommend an anti-depressant, for example, it is code for "I think this is all in your head." In fact, these medications are very well studied and can be life changing for certain individuals.

In addition, these medications further "turn down the volume" of an over-active gut nervous system. If you go into therapy expecting side effects, you will likely find them and studies have shown this and call it the "nocebo effect." Essentially, it is the opposite of the placebo effect, where you expect positive outcomes and then experience them.

It is also recommended that patients view new medication as an opportunity for symptom improvement, and to remember that dealing with IBS is a marathon, not a sprint.

While this can be challenging, more effective medications and studies including natural and herbal remedies and cannabis are forthcoming to provide further hope for patients suffering from this condition.