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Irritable Bowel Syndrome (Holistic)

Irritable Bowel Syndrome (Holistic)

About This Condition

IBS—not your typical tummy ache. Symptoms may include abdominal bloating and soreness, gas, alternating diarrhea and constipation, backaches, and fatigue. According to research or other evidence, the following self-care steps may be helpful.
  • Find the right fiber

    Try different fiber sources, including high-fiber foods such as flaxseed, rye, brown rice, oatmeal, barley, and vegetables, as well as bulk-forming laxatives like psyllium husk and methylcellulose, to find the right balance of regularity without episodes of diarrhea

  • Avoid problem foods

    Experiment with limiting dairy products and beans, as well as foods containing caffeine, fructose, or sorbitol, to see which restrictions may help reduce your symptoms

  • Try peppermint and caraway oils

    Taking a coated herbal supplement providing 0.2 to 0.4 ml of peppermint oil, preferably combined with 50 mg of caraway oil, three times a day may reduce gas production, ease intestinal cramping, and soothe the intestinal tract

  • Explore food sensitivities

    Work with a specialist to identify other foods that aggravate your condition

About

About This Condition

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that sometimes causes significant discomfort even though it is not a serious health threat. 

The cause of IBS remains unknown. IBS is not related to inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis .

Symptoms

Typical symptoms include abdominal bloating and soreness, gas, and alternating diarrhea and constipation . People with IBS are more likely than others to have backaches , fatigue, and several other seemingly unrelated problems.

Holistic Options

IBS sufferers have increased sensitivity to rectal pain that has been linked to psychological factors.1 Stress is known to increase symptoms of IBS.2 Reducing stress or practicing stress management skills have been reported to be beneficial. In one trial, psychotherapy and relaxation combined with conventional treatment were more effective than conventional treatment alone in two-thirds of people with IBS.3 Hypnosis for relaxation has dramatically and consistently relieved symptoms of IBS in some people.4 , 5 , 6

Traditional Chinese Medicine (TCM), which uses acupuncture and Chinese herbal therapies, has been reported to be helpful in the treatment of IBS,7 although no formal research has evaluated this claim.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Find the right fiber
Try different fiber sources, including flaxseed, rye, brown rice, oatmeal, barley, and vegetables, to find the right balance of regularity without episodes of diarrhea.

Limited research has suggested that fiber might help people with IBS.8 , 9 However, most studies find that IBS sufferers do not benefit by adding wheat bran to their diets,10 , 11 , 12 , 13 and some people feel worse as a result of wheat bran supplementation.14 The lack of positive response to wheat bran may result from a wheat sensitivity,15 which is one of the most common triggers for food sensitivity in people with IBS.16Rye, brown rice, oatmeal, barley, vegetables, and psyllium husk are good sources of fiber and are less likely to trigger food sensitivities than is wheat bran. Except for psyllium, little is known about the effects of these other fibers in people with IBS.
Avoid problem foods
Try replacing dairy products and foods containing fructose and sorbitol with alternative dairy and sweetened products to see which restrictions may help reduce your symptoms.

There is evidence that some people with IBS have greater trouble absorbing the sugars lactose (as found in milk), fructose (as found in high concentration in fruit juice and dried fruit), and sorbitol (as found in some dietetic candy) than do healthy people.17 , 18 In those people, restricting intake of the sugars that they have difficulty absorbing frequently decreases the symptoms of IBS. Fructose and lactose are among the list of foods that contain fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). Other foods high in FODMAPs include wheat, legumes, and foods high in sorbitol. Consumption of a low-FODMAP diet has been found to improve IBS symptoms in a high proportion of cases.19

Explore food sensitivities
Work with a specialist to identify foods that aggravate your Condition.

Several trials report that food sensitivities occur in only a small percentage of people with IBS.20 , 21 , 22 However, a leading researcher in the field claims at least 3.5 ounces of the offending food need to be consumed at frequent intervals to provoke IBS symptoms,23 and the amount of test foods used in these studies was generally less than this amount. Therefore, inadequate quantities of food may have affected the outcomes of these trials. Other trials have reported that most IBS sufferers have food sensitivities, and that gas production and IBS symptoms diminish when the offending foods are discovered and avoided.24 , 25 , 26 , 27 Some researchers report that problem foods need to be eaten at every meal for at least two days to evaluate the potential of food sensitivity.28

Researchers have found that standard blood tests used to evaluate allergies may not uncover food sensitivities associated with IBS, because IBS food sensitivities may not be true allergies.29 , 30 The only practical way to evaluate which foods might trigger IBS symptoms is to avoid the foods and then reintroduce them. Such a procedure requires the guidance of a healthcare practitioner. Attempts to find and avoid problem foods without professional help may fail and may aggravate symptoms.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
3 Stars
Caraway Oil and Peppermint Oil
90 mg of peppermint oil plus 50 mg of caraway oil in enteric-coated capsules taken three times per day
Taking peppermint oil combined with caraway oil may reduce gas production, ease intestinal cramping, and soothe the intestinal tract.

The combination of 90 mg of peppermint oil plus 50 mg of caraway oil in enteric-coated capsules taken three times per day led to significant reduction in IBS symptoms in a double-blind trial.31 In a similar trial, capsules that were not enteric-coated were as effective as enteric-coated capsules.32 The same combination has compared favorably to the drug cisapride (Propulsid) in reducing symptoms of IBS.33 The purpose of enteric coating is to protect peppermint oil while it is passing through the acid environment of the stomach.

Whole peppermint leaf is often used either alone or in combination with other herbs to treat abdominal discomfort and mild cramping that accompany IBS. The combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in a double-blind trial.34

3 Stars
Lactase (Lactose Intolerance)
6,000 to 9,000 IU tablets chewed with a meal containing lactose, or add 1,000 IU in liquid form to 8 ounces of milk
Lactase enzymes taken prior to consuming milk or dairy products may help ease IBS symptoms.

Double-blind research has shown that avoidance of lactose (present in milk and some other dairy products) by people with IBS who are also lactose intolerant will relieve IBS symptoms.35 Alternatively, lactase enzyme may be used prior to consuming milk. Several different lactase products are commercially available and the amount needed depends on the specific preparation being used.
3 Stars
Probiotics
Refer to label instructions
A daily drink containing probiotics significantly reduced IBS symptoms in one study.
In several double-blind trials, probiotic products have been found to relieve symptoms of IBS. Preparations that have been found to be effective include 1) a combination of Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Propionibacterium freudenreichii ssp. shermanii JS and Bifidobacterium animalis ssp. lactis Bb12;36 2) Lactobacillus GG;37 3) a combination of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07;38 and 4) a product known as VSL#339
3 Stars
Psyllium
3.25 grams taken three times per day
Some people with IBS may benefit from bulk-forming laxatives. Psyllium has helped regulate normal bowel activity and improved symptoms in some people with IBS.

Some people with IBS may benefit from bulk-forming laxatives. Psyllium seeds (3.25 grams taken three times per day) have helped regulate normal bowel activity in some people with IBS.40 Psyllium has improved IBS symptoms in double-blind trials.41 , 42

2 Stars
Melatonin
Take under medical supervision: 3 mg daily at bedtime
Melatonin helps regulate gastrointestinal function and sensation. In one trial, people with irritable bowel syndrome who took melatonin experienced significantly less severe abdominal pain.

Melatonin plays a role in the regulation of gastrointestinal function and sensation. In a double-blind trial, people with irritable bowel syndrome and associated sleep disturbances received 3 mg of melatonin or a placebo at bedtime for two weeks. Compared with the placebo, melatonin significantly decreased the severity of abdominal pain, although it did not affect bloating, stool frequency, or sleep patterns.43 Melatonin was also effective in another double-blind trial.44

2 Stars
Peppermint
0.2 to 0.4 ml in enteric-coated capsules, three times per day
Peppermint oil reduces gas production, eases intestinal cramping, and soothes irritation. It has been reported to help relieve IBS symptoms in two analyses of controlled trials.

In the intestinal tract, peppermint oil reduces gas production, eases intestinal cramping, and soothes irritation.45 Peppermint oil has been reported to help relieve symptoms of IBS in two analyses of controlled trials.46 , 47 Evidence supporting the use of peppermint oil has come from double-blind trials that typically have used enteric-coated capsules that supply 0.2–0.4 ml of peppermint oil taken two to three times per day.48 , 49 , 50 , 51 , 52 Some trials have found peppermint oil ineffective.53 , 54 The reason for these conflicting findings remains unclear.

The combination of 90 mg of peppermint oil plus 50 mg of caraway oil in enteric-coated capsules taken three times per day led to significant reduction in IBS symptoms in a double-blind trial.55 In a similar trial, capsules that were not enteric-coated were as effective as enteric-coated capsules.56 The same combination has compared favorably to the drug cisapride (Propulsid) in reducing symptoms of IBS.57 The purpose of enteric coating is to protect peppermint oil while it is passing through the acid environment of the stomach.

Whole peppermint leaf is often used either alone or in combination with other herbs to treat abdominal discomfort and mild cramping that accompany IBS. The combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in a double-blind trial.58

2 Stars
Peppermint, Caraway Seeds, Fennel Seeds, and Wormwood
Refer to label instructions
A combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in one trial.

Whole peppermint leaf is often used either alone or in combination with other herbs to treat abdominal discomfort and mild cramping that accompany IBS. The combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in a double-blind trial.59

1 Star
Artichoke
Refer to label instructions
In a preliminary study of people with irritable bowel syndrome who took an artichoke leaf extract daily for two months, 26% reported an improvement in symptoms.

In a preliminary study of people with irritable bowel syndrome who took an artichoke leaf extract daily for two months, 26% reported an improvement in symptoms.60 Because no placebo group was used in this study and because irritable bowel syndrome has a high rate of response to placebo, additional research is needed to confirm this report. The amount of artichoke leaf used in the study was 320 or 640 mg per day of a 1:5 standardized extract.
1 Star
Chamomile
Refer to label instructions
Chamomile’s essential oils may ease intestinal cramping and irritation. The herb is sometimes used by herbalists to relieve alternating bouts of diarrhea and constipation.

Chamomile’s essential oils have eased intestinal cramping and irritation in animals.61 Chamomile is sometimes used by herbalists to relieve alternating bouts of diarrhea and constipation , though research has yet to investigate these effects. This herb is typically taken three times per day, between meals, in a tea form by dissolving 2–3 grams of powdered chamomile or by adding 3–5 ml of herbal extract tincture to hot water.
1 Star
Evening Primrose Oil (Premenstrual Syndrome)
Refer to label instructions
In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking evening primrose oil.

In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking enough evening primrose oil (EPO) to provide 360–400 mg of gamma linolenic acid (GLA) per day.62 In that trial more than half reported improvement with EPO, but none was helped in the placebo group. The effects of EPO in other groups of IBS sufferers have not been explored.
1 Star
Fennel
Refer to label instructions
A combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in one trial.

Whole peppermint leaf is often used either alone or in combination with other herbs to treat abdominal discomfort and mild cramping that accompany IBS. The combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in a double-blind trial.63

1 Star
Fiber
Refer to label instructions
Supplementing with fiber may help you find the right balance of regularity without episodes of diarrhea.
Limited research has suggested that fiber might help people with IBS.64 , 65 However, most studies find that IBS sufferers do not benefit by adding wheat bran to their diets,66 , 67 , 68 , 69 and some people feel worse as a result of wheat bran supplementation.70 The lack of positive response to wheat bran may result from a wheat sensitivity,71 which is one of the most common triggers for food sensitivity in people with IBS.72 Rye, brown rice, oatmeal, barley, vegetables, and psyllium husks are good sources of fiber and are less likely to trigger food sensitivities than is wheat bran. Except for psyllium, little is known about the effect of these other fibers in people with IBS.
1 Star
Grapefruit Seed Extract
Refer to label instructions
In one study, grapefruit seed extract improved IBS symptoms in 20% of people taking the liquid, while all of the patients taking capsules noted definite improvement of constipation, flatulence, abdominal discomfort, and night rest.

A preliminary trial investigated the effectiveness of grapefruit seed extract in people with eczema and symptoms of IBS.73 Participants received either 2 drops of a 0.5% oral solution of grapefruit seed extract twice daily or 150 mg of encapsulated grapefruit seed extract three times daily. After a month, IBS symptoms had improved in 20% of those taking the liquid, while all of the patients taking capsules noted definite improvement of constipation, flatulence, abdominal discomfort, and night rest. These results need confirmation in double-blind trials.
1 Star
Wormwood, Ginger, Bupleurum, Schisandra, Dan Shen, and Other Extracts
Take a Chinese herbal formula containing wormwood under the guidance of a qualified practitioner
A standardized Chinese herbal combination containing extracts from plants including wormwood, ginger, bupleurum, schisandra, and dan shen reduced IBS symptoms in one study.

Whole peppermint leaf is often used either alone or in combination with other herbs to treat abdominal discomfort and mild cramping that accompany IBS. The combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in a double-blind trial.74

0 Stars
Magnesium Citrate
Refer to label instructions
 

References

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2. Dancey CP, Taghavi M, Fox RJ. The relationship between daily stress and symptoms of irritable bowel: a time-series approach. J Psychosom Res 1998;44:537–45.

3. Guthrie E, Creed F, Dawson D, Tomenson BG. AA controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991;100:450–7.

4. Harvey RF. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989;i:424–6.

5. Waxman D. The irritable bowel: a pathological or a psychological syndrome? J R Soc Med 1988;81:718–20.

6. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy. Aliment Pharmacol Ther 1996;10:91–5.

7. Pagon A. Treatment by traditional oriental medicine. Irritable bowel syndrome. J Chin Med 1998;58:28–31.

8. Manning AP, Heaton KW, Harvey RF, Uglow P. Wheat fibre and irritable bowel syndrome. Lancet 1977;ii:417–8.

9. Hotz J, Plein K. Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645–51.

10. Cann PA, Read NW, Holdsworth CD. What is the benefit of coarse wheat bran in patients with irritable bowel syndrome? Gut 1984;25:168–73.

11. Arffmann S, Andersen JR, Hegnhoj J, et al. The effect of coarse wheat bran in the irritable bowel syndrome. A double-blind cross-over study. Scand J Gastroenterol 1985;20:295–8.

12. Soloft J, Krag B, Gudmand-Hoyer E, et al. A double-blind trial of the effect of wheat bran on symptoms of irritable bowel syndrome. Lancet 1976;i:270–3.

13. Lucey MR, Clark ML, Lowndes J, Dawson AM. Is bran efficacious in irritable bowel syndrome? A double blind placebo controlled crossover study. Gut 1987;28:221–5.

14. Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994;344:39–40.

15. Gaby AR. Commentary. Nutrition and Healing 1996;Feb:1,10–1 [review].

16. Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184–90 [review].

17. Fernandez-Banares F, Esteve-Pardo M, de Leon R, et al. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol 1993;88:2044–50.

18. Choi YK, Kraft N, Zimmerman B, et al. Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol 2008;42:233–8.

19. Staudacher HM, Whelan K, Irving PM, Lomer MCE. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011;24:487–95.

20. Bentley SJ, Pearson DJ, Rix KJ. Food hypersensitivity in irritable bowel syndrome. Lancet 1983;ii:295–7.

21. McKee AM, Prior A, Whorwell PJ. Exclusion diets in irritable bowel syndrome: are they worthwhile? J Clin Gastroenterol 1987;9:526–8.

22. Farah DA, Calder I, Benson L, Mackenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut 1985;26:164–8.

23. Alun Jones V, Shorthouse M, Workman E, Hunter JO. Food intolerance and the irritable bowel. Lancet 1983; ii:633–4 [letter].

24. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998;352:1187–9.

25. Alun Jones V, McLaughlan P, Shorthouse M, et al. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;ii:1115–7.

26. Smith MA, Youngs GR, Finn R. Food intolerance, atopy, and irritable bowel syndrome. Lancet 1985;ii:1064 [letter].

27. Parker TJ, Naylor SJ, Riordan AM, Hunter JO. Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. J Hum Nutr Diet 1995;8:159–66.

28. Birtwistle S. Letter. Lancet 1983; II:634.

29. Paganelli R, Fagiolo U, Cancian M, et al. Intestinal permeability in irritable bowel syndrome. Effect of diet and sodium cromoglycate administration. Ann Allergy 1990;64:377–80.

30. Alun Jones V, McLaughlan P, Shorthouse M, et al. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;ii:1115–7.

31. May B Kuntz HD, Kieser M, Kohler S. Efficacy of a fixed peppermint/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung 1996;46:1149–53.

32. Friese J, Köhler S. Peppermint/caraway oil-fixed combination in non-ulcer dyspepsia: equivalent efficacy of the drug combination in an enteric coated or enteric soluble formula. Pharmazie 1999;54:210–5.

33. Madisch A, Heydenreich CJ, Wieland V, et al. Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. Arneimittlforschung 1999;49:925–32.

34. Westphal J, Hörning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomedicine 1996;2:285–91.

35. Bohmer CJ, Tuynman HA. The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol 1996;8:1013–6.

36. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther 2008;27:48–57.

37. Francavilla R, Miniello V, Magista AM, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics 2010;126:e1445–52.

38. Ringel Y, Ringel-Kulka T, Maier D, et al. Probiotic bacteria: probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients With functional bowel disorders - a double-blind study. J Clin Gastroenterol 2011;45:518–25

39. Guandalini S, Magazzu G, Chiaro A, et al. VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study. J Pediatr Gastroenterol Nutr 2010;51:24–30.

40. Hotz J, Plein K. Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645–51.

41. Jalihal A, Kurian G. Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction. J Gastroenterol Hepatol 1990;5:507–13.

42. Prior A, Whorwell PJ. Double blind study of ispaghula irritable bowel syndrome. Gut 1987;11:1510–3.

43. Song GH, Leng PH, Gwee KA, et al. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut 2005;54:1402–7.

44. Saha L, Malhotra S, Rana S, et al. A preliminary study of melatonin in irritable bowel syndrome. J Clin Gastroenterol 2007;41:29–32.

45. Leicester RJ, Hunt RH. Peppermint oil to reduce colonic spasm during endoscopy. Lancet 1982;ii:989 [letter].

46. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol 1998;93:1131–5.

47. Poynard T, Naveau S, Mory B, Chaput JC. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 1994;8:499–510.

48. Rees WD, Evans BK, Rhodes J. Treating irritable bowel syndrome with peppermint oil. Br Med J 1979;2(6194):835–6.

49. Liu J-H, Chen G-H, Yeh H-Z, et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997;32:765–8.

50. Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: A multi-center trial. Br J Clin Pract 1984;38:394–8.

51. Cappello G, Spezzaferro M, Grossi L, et al. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis 2007;39:530–6.

52. Merat S, Khalili S, Mostajabi P, et al. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci 2010;55:1385–90.

53. Nash P, Gould SR, Barnardo DE. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract 1986;40:292–3.

54. Rogers J, Tay HH, Misiewicz JJ. Peppermint oil. Lancet 1988;ii:98–9 [letter].

55. May B Kuntz HD, Kieser M, Kohler S. Efficacy of a fixed peppermint/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung 1996;46:1149–53.

56. Friese J, Köhler S. Peppermint/caraway oil-fixed combination in non-ulcer dyspepsia: equivalent efficacy of the drug combination in an enteric coated or enteric soluble formula. Pharmazie 1999;54:210–5.

57. Madisch A, Heydenreich CJ, Wieland V, et al. Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. Arneimittlforschung 1999;49:925–32.

58. Westphal J, Hörning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomedicine 1996;2:285–91.

59. Westphal J, Hörning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomedicine 1996;2:285–91.

60. Bundy R, Walker AF, Middleton RW, et al. Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. J Altern Complement Med 2004;10:667–9.

61. Achterrath-Tuckerman U, Kunde R, et al. Pharmacological investigations with compounds of chamomile. V. Investigations on the spasmolytic effect of compounds of chamomile and Kamillosan® on isolated guinea pig ileum. Planta Med 1980;39:38–50.

62. Cotterell CJ, Lee AJ, Hunter JO. Double-blind cross-over trial of evening primrose oil in women with menstrually-related irritable bowel syndrome. In Omega-6 Essential Fatty Acids: Pathophysiology and roles in clinical medicine, Alan R Liss, New York, 1990, 421–6.

63. Westphal J, Hörning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomedicine 1996;2:285–91.

64. Manning AP, Heaton KW, Harvey RF, Uglow P. Wheat fibre and irritable bowel syndrome. Lancet 1977;ii:417–8.

65. Hotz J, Plein K. Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645–51.

66. Cann PA, Read NW, Holdsworth CD. What is the benefit of coarse wheat bran in patients with irritable bowel syndrome? Gut 1984;25:168–73.

67. Arffmann S, Andersen JR, Hegnhoj J, et al. The effect of coarse wheat bran in the irritable bowel syndrome. A double-blind cross-over study. Scand J Gastroenterol 1985;20:295–8.

68. Soloft J, Krag B, Gudmand-Hoyer E, et al. A double-blind trial of the effect of wheat bran on symptoms of irritable bowel syndrome. Lancet 1976;i:270–3.

69. Lucey MR, Clark ML, Lowndes J, Dawson AM. Is bran efficacious in irritable bowel syndrome? A double blind placebo controlled crossover study. Gut 1987;28:221–5.

70. Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994;344:39–40.

71. Gaby AR. Commentary. Nutrition and Healing 1996;Feb:1,10–1 [review].

72. Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184–90 [review].

73. Ionescu G, Kiehl R, Wichmann-Kunz F, et al. Oral citrus seed extract in atopic eczema: In vitro and in vivo studies on intestinal microflora. J Orthomol Med 1990;5:155–8.

74. Westphal J, Hörning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomedicine 1996;2:285–91.

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